Seychelles: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 50

Seychelles has a national Antimicrobial Resistance (AMR) action plan draft that was developed, but its implementation, particularly concerning a comprehensive surveillance, detection, and reporting system for priority AMR pathogens, has been noted as a significant gap.

The Joint External Evaluation (JEE) report from March 2018 indicated that a National Action Plan for Antimicrobial Resistance was "in draft form" following a situational analysis workshop in May 2017 (p. 9). This report, dating to 2018, explicitly stated that "There is no national AMR action plan in place" and recommended completing its development (p. 10). It also highlighted that "There is no established system for surveillance of resistant pathogens for human, animal and environmental health" (p. 11). ¹

By 2021, the Tripartite AMR Country Self-Assessment Survey (TrACSS) report indicated that the country had achieved "developed capacity" in terms of "Country progress with development of a national action plan on AMR" in both 2019 and 2021 (p. 2). However, the same report also showed a cross mark, signifying "no," for "Country is implementing their AMR NAP" (p. 1). This contradiction suggests the plan was formally developed but its active implementation was lacking. ² This is further corroborated by the Infection Prevention and Control Strategic Framework 2021-2025 which, under its legislative mandates, lists an "AMR Strategic Framework – 2017" (p. 6) but clarifies that "An AMR action plan was developed in 2017 but is yet to be implemented" (p. 9). The IPC framework also mentions supporting the implementation of the AMR action plan, including strengthening AMR surveillance (p. 35). ³

The Seychelles News Agency reported on September 19, 2022, that experts from FAO and Seychelles were meeting to draft an AMR action plan. It mentions that "The Seychelles draft national action plan on antimicrobial resistance, which was developed in 2017 and validated in 2018, was used during the workshop". ⁴ The WHO Strategic Partnership Portal indicates that a "National AMR action plan [is] under development. ⁵

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

Score: 50

There is a national laboratory system in Seychelles that tests for priority antimicrobial resistance (AMR) pathogens in human health, but not for all 7+1 AMR priority pathogens.

The national Clinical Laboratory serves as the designated national reference laboratory for AMR, possessing the capability to test susceptibility on all infectious isolates using the disc diffusion method and interpreting results according to Clinical Laboratory Standards Institute Antimicrobial Sensitivity Test (CLSI AST) standards, as stated in the Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report (p. 10). This report, from a World Health Organization (WHO) mission in March 2018, evaluates Seychelles' capacities under the International Health Regulations (IHR) across various technical areas, including antimicrobial resistance. It also notes that laboratories in Seychelles can detect and report multi-drug resistant Staphylococcus aureus (MRSA) and other multi-drug resistant organisms (MDROs) (p. 11). ⁶

The Annual Health Sector Performance Report 2023, published by the Ministry of Health, provides a comprehensive review of the health sector's work and performance for the year 2023. This report confirms ongoing surveillance, noting that in 2023, Klebsiella pneumoniae and Acinetobacter baumanii were the two most identified MDROs, primarily from endotracheal tube secretions, with an increasing number of multi-drug resistant Enterococci species also identified, mainly from blood cultures and pus (p. 35). This report also specifies that 73 samples of Neisseria gonorrhoeae were tested for resistance patterns in 2023, showing a significant increase in resistance to Ceftriaxone and Cefixime compared to pre-pandemic levels (p. 36). ⁷ Based on the provided documents, the testing explicitly mentions these specific pathogens, rather than an exhaustive list of "all 7+1 priority pathogens."

The 2021 TrACSS Country Report on the Implementation of National Action Plan on Antimicrobial Resistance (AMR), published by the WHO and summarizing Seychelles' responses to a self-assessment survey, indicates "developed capacity" for a national surveillance system for AMR in humans (p. 2). However, the same TrACSS report notes "no capacity" for a national surveillance system for AMR in animals and "no capacity" for AMR in food (animal and plant origin) (p. 2). ⁸ The Infection Prevention and Control 5-YEAR Strategic Framework 2021-2025, a Ministry of Health document outlining a roadmap for IPC practices, also points out that the system for laboratory-based surveillance of hospitalized patients, where positive results of MDROs are communicated to the IPC unit, is "not functioning well" and that an AMR action plan draft developed in 2017 is "yet to be implemented" (p. 9). ⁹

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no established system for environmental detection or surveillance activities for antimicrobial resistance (AMR) organisms in Seychelles.

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles, a report from a World Health Organization mission, explicitly stated that there was "no established system for surveillance of resistant pathogens for human, animal and environmental health" (p. 11). ¹⁰

The 2021 TrACSS Country Report on the Implementation of National Action Plan on Antimicrobial Resistance (AMR), a self-assessment by Seychelles, further highlighted this gap by rating the national surveillance system for AMR in animals and in food (animal and plant origin) as having "no capacity" ("A" score) (p. 2). While "Environmental Health" was identified as a sector involved in the development and implementation of the AMR National Action Plan (p. 1), the plan itself was noted as not being fully implemented. ¹¹

The Infection Prevention and Control 5-YEAR Strategic Framework 2021-2025, a Ministry of Health document, mentioned a planned activity to "Collaborate with the Public Health Laboratory to institute systems for targeted environmental surveillance" (p. 20). However, this was presented as an intervention under "Institute HAIs surveillance," suggesting it was focused on healthcare-associated infections (HAIs) rather than a broad governmental environmental surveillance for AMR organisms or residues in general waterways or soil. ¹²

The Annual Health Sector Performance Report 2023, published by the Ministry of Health, indicated ongoing "hospital hygiene monitoring" which expanded to all hospital wards in 2023, but this refers to the hospital environment rather than the broader natural environment (p. 38). The report also noted an increase in "effluent water samples that did not meet Environment Protection Act standards" and increased chlorophyll-A in sea water, suggesting general environmental contamination but not specifically detailing surveillance for antimicrobial residues or AMR organisms in soil or waterways (p. 38). ¹³ Therefore, governmental activities directly for environmental detection of antimicrobial residues or AMR organisms in soil or waterways were not established or systematically reported in the narional documents.

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

Score: 0

National legislation or regulation specifically requiring prescriptions for antibiotic use for humans is not explicitly stated as being in place.

The 2021 TrACSS Country Report on the Implementation of National Action Plan on Antimicrobial Resistance (AMR), which assesses the country's progress on AMR, directly states "No" to the question "Country has laws/regulations on prescription/sale of antimicrobials for human use" (p. 1, 3). ¹⁴

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, a 2018 report, mentioned that while there is a "Medicines Act" and a "restriction on importing and dispensing antibiotics for human and animal health," there was "no up-to-date legislation on antibiotic use in animals and humans" (p. 9). Furthermore, the JEE identified a "need for legislation and regulation on medicine use, to control private practice and veterinary use of antimicrobials" as an area requiring strengthening for antimicrobial stewardship activities (p. 12). ¹⁵ This implies that any existing restrictions were not considered comprehensive or adequately enforced as a universal prescription requirement by 2018, a finding reinforced by the later 2021 TrACSS report.

The Infection Prevention and Control 5-YEAR Strategic Framework 2021-2025, from the Ministry of Health, notes that an "AMR action plan was developed in 2017 but is yet to be implemented" and highlights the need to "optimize the use of antimicrobial medicines in human and animal health" (p. 21), indicating ongoing efforts to manage antibiotic use rather than confirming existing prescriptive legislation. ¹⁶ The Annual Health Sector Performance Report 2023, while mentioning an alert and recall of Cloxacillin antibiotics, does not detail general prescriptive legislation (p. 42). ¹⁷

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ¹⁸¹⁹²⁰

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

Score: 0

There is no national legislation or regulation explicitly identified in the provided documents as being in place to require prescriptions for antibiotic use for animals.

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report, from March 2018, noted that "Seychelles has no up-to-date legislation on antibiotic use in animals and humans (the current legislation covering this area is the Medicines Act), there is a restriction on importing and dispensing antibiotics for human and animal health" (p. 9). This report further highlighted a "need for legislation and regulation on medicine use, to control private practice and veterinary use of antimicrobials" in its section on strengthening antimicrobial stewardship activities (p. 12). ²¹

More recently, the 2021 TrACSS Country Report on the Implementation of National Action Plan on Antimicrobial Resistance (AMR), which represents Seychelles' self-assessment, explicitly answered "No" to the question "Country has laws on prescription and sale of antimicrobials for animal use" (p. 3). This indicates that as of 2021, such specific legislation was not considered to be in place. ²²

Other national documents, such as the National Health Strategic Plan 2022-2026, the Infection Prevention and Control 5-YEAR Strategic Framework 2021-2025, and the Annual Health Sector Performance Report 2023, discuss the broader issue of antimicrobial resistance and the optimization of antimicrobial use in both human and animal health, but they do not mention the establishment of new legislation or regulation requiring prescriptions for antibiotic use in animals that would contradict the findings of the 2018 JEE or the 2021 TrACSS report. ²³²⁴²⁵ The Infection Prevention and Control Strategic Framework mentions optimizing the use of antimicrobial medicines in human and animal health (p. 21), but this is a strategic objective within a framework, not an indication of existing prescriptive legislation for animal use. ²⁶

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ²⁷²⁸²⁹

1.2.1a Laws/plans on zoonotic disease

Score: 100

National legislation, plans, and equivalent strategy documents for zoonotic disease prioritization, detection, and reporting are in place in Seychelles, although with identified areas for further strengthening.

The country has explicitly identified priority zoonotic diseases, which include Leptospirosis, Avian influenza, Middle East respiratory syndrome (MERS-CoV), Salmonella, Giardia, Rift Valley fever, and West Nile fever, indicating a clear prioritization strategy as outlined in the Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018 (p. 13). This same report notes that the Public Health Act makes provisions for the mandatory reporting of unusual diseases and deaths in animals, establishing a legal basis for reporting (p. 15). ³⁰

For detection and reporting, the public health sector maintains a functioning surveillance system that includes Integrated Disease Surveillance and Response (IDSR), event-based surveillance, syndromic surveillance, rumor tracking, obligatory reporting, and laboratory confirmation of suspected cases (p. 13). However, the animal health sector's surveillance system was noted in 2018 as not being well established, facing challenges such as a lack of clear structure, inadequate manpower, and limited funding (p. 13). ³¹

The National Health Strategic Plan 2022-2026, published in June 2022, identifies "zoonotic diseases" as priority infectious diseases and commits to strengthening the "One Health approach," which promotes multi-stakeholder collaboration for better public health outcomes, including for zoonoses (p. 34, p. 55). Specific objectives within this plan include strengthening the One Health approach, implementing International Health Regulations (IHR) for preventing, detecting, and managing outbreaks, and implementing IDSR, with milestones such as establishing a National One Health Coordination Committee and widely disseminating revised IDSR guidelines and standard operating procedures (p. 39, p. 58). ³²

The Annual Health Sector Performance Report 2023, published in July 2024, further indicates ongoing activities for detection and reporting. It states that a Strategic (Public Health) Risk Assessment was undertaken in October 2023, which assisted in identifying priority health threats within the Seychelles context, reinforcing the prioritization aspect (p. 32). This report confirms that disease investigations for reported cases of dengue and leptospirosis were conducted in 2023 (p. 37). Additionally, approximately 6,500 notifiable diseases were reported to the Disease Surveillance and Response Unit (DSRU) in 2023, demonstrating an active reporting mechanism for various conditions, including zoonotic ones (p. 38). It also notes the country's participation in the regional Réseau SEGA surveillance platform, which is expanding to include climate-sensitive diseases and health risks, including forecasting and early warning systems ( p. 37). ³³

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

Score: 100

National legislation, plans, and equivalent strategy documents include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans in Seychelles.

The country officially recognizes zoonotic diseases as a significant health concern and has prioritized specific ones, such as Leptospirosis, Avian influenza, Middle East respiratory syndrome (MERS-CoV), Salmonella, Giardia, Rift Valley fever, and West Nile fever, as noted in the Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018 (p. 13). ³⁴

This 2018 report highlights that the Animal and Plant Biosecurity Act 2014 provides a legal foundation for biosecurity measures, and the dedicated National Biosecurity Agency enforces sanitary and phytosanitary (SPS) measures to prevent the introduction of new pathogens, thereby reducing spillover risk (p. 15). Furthermore, a multi-sectoral preparedness and response plan specifically for avian influenza was in place by 2018 (p. 15). However, the same report identified that overall multi-sectoral collaboration between human, animal, and environmental health sectors remained weak, hindering effective management of zoonotic events (p. 13-14), and recommended establishing a national One Health coordination committee and developing multi-sectoral prevention and control/preparedness and response plans for priority zoonotic diseases (p. 14). ³⁵

The National Health Strategic Plan 2022-2026, published in June 2022, emphasizes strengthening the "One Health approach" to achieve better public health outcomes, including the prevention of illnesses and disease outbreaks in people (p. 55). It outlines a strategic direction (SD3) to improve health security, with specific objectives such as strengthening the One Health approach and implementing the International Health Regulations (IHR) to prevent, detect, and respond to all health emergencies (p. 39). Milestones include establishing a National One Health Coordination Committee and formalized processes for communication between animal and human health sectors (p. 58). This plan also states that the National Action Plan for Health Security (NAPHS) will guide the process to strengthen multi-sectoral collaboration for prevention, detection, and response to zoonoses and food safety problems (p. 55-56). ³⁶

More recently, the Annual Health Sector Performance Report 2023, published in July 2024, indicates ongoing activities that contribute to risk identification and reduction. It notes that a Strategic (Public Health) Risk Assessment was conducted in October 2023, which identified priority health threats in the Seychelles context (p. 32). The Public Health Services team inspected sea vessels and airplanes for public health risks, including invasive species, to prevent the introduction of threats (p. 37). The report also mentions the ongoing development of a national vector control plan, which is a measure to prevent the transmission of vector-borne diseases, some of which are zoonotic (p. 37). Additionally, Seychelles' participation in the regional Réseau SEGA surveillance platform, which is expanding to include climate-sensitive diseases and health risks for forecasting and early warning, indirectly contributes to managing zoonotic spillover given the link between climate and zoonotic disease ecology (p. 37). ³⁷

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

Score: 100

There is national legislation, plans, and guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern in Seychelles.

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles, from March 2018, explicitly states that the country has established a list of seven priority zoonotic diseases: Leptospirosis, Avian influenza, Middle East respiratory syndrome – coronavirus (MERS-CoV), Salmonella, Giardia, Rift Valley fever, and West Nile fever (p. 13). This indicates a clear prioritization of multiple zoonotic pathogens. The Public Health Act provides for mandatory reporting of unusual diseases and deaths in animals, forming a legislative basis for surveillance (p. 15). While acknowledging that a national multisectoral surveillance plan for these priority diseases did not yet exist in 2018, the report noted the public health sector’s functioning surveillance system, which utilizes the Integrated Disease Surveillance and Response (IDSR) strategy for detecting and reporting zoonotic diseases through various approaches including event-based and syndromic surveillance (p. 13). However, it highlighted weaknesses in the animal health sector's surveillance system and a lack of formalized, streamlined multi-sectoral collaboration for surveillance and response to zoonotic events (p. 13-14). ³⁸

The National Health Strategic Plan 2022-2026, published in June 2022, addresses these gaps by committing to strengthening the "One Health approach," which emphasizes multi-stakeholder collaboration for preventing illnesses and disease outbreaks, including zoonoses (p. 55). Under Strategic Direction 3 (SD3), "Improve Health Security," specific objectives include strengthening the One Health approach, implementing the IHR to prevent, detect, and manage outbreaks, and implementing IDSR (p. 39). Key milestones for these objectives involve establishing a National One Health Coordination Committee with formalized communication processes between animal and human health sectors, and rolling out revised IDSR guidelines and training to both human and animal health staff (p. 58). It notes that Seychelles validated the 3rd Edition IDSR Technical Guidelines in August 2019, but their rollout was delayed by the COVID-19 pandemic. The NHSP commits to implementing these revised guidelines to "support the implementation of a robust disease surveillance system for early detection of outbreaks and swift response" (p. 56). The plan also highlights that the country already "conducts surveillance for newly emerging or re-emerging diseases that threaten health security" (p. 56). The plan also identifies the future National Action Plan for Health Security (NAPHS) as the guiding document for strengthening multi-sectoral collaboration in response to zoonoses (p. 56). ³⁹

Further evidence of accounting for multiple zoonotic pathogens is found in the Annual Health Sector Performance Report 2023, published in July 2024. This report confirms that the Disease Surveillance and Response Unit (DSRU) received reports on approximately 6,500 notifiable diseases in 2023, and disease investigations were undertaken for specific zoonotic conditions like dengue (254 cases) and leptospirosis (4 cases) (p. 37, p. 38). It also mentions the ongoing development of a national vector control plan to prevent the transmission of vector-borne diseases, many of which are zoonotic (p. 37). Seychelles' participation in the regional Réseau SEGA surveillance platform is highlighted, noting its expansion to include climate-sensitive diseases and health risks for forecasting and early warning, which implicitly covers multiple zoonotic pathogens influenced by environmental factors (p. 37). ⁴⁰ While progress is ongoing, the documented strategic direction and implemented activities confirm that national frameworks exist for multiple zoonotic pathogens.

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

Score: 100

A multi-sectoral coordinating mechanism is in place, functioning across ministries and addressing zoonotic disease aspects.

According to the Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles, the Integrated Disease Surveillance and Response (IDSR) Committee serves as a multi-sectoral and multidisciplinary coordination mechanism that has been active since 2003. This committee provides a platform for intersectoral collaboration, explicitly including both the animal health and human health sectors. Its membership draws from various entities, including the Veterinary Department (typically under a Ministry of Agriculture), the Epidemiology Unit of the Public Health Authority (PHA), the Health Care Agency (HCA), and clinical and public health laboratories (p. 7). The committee meets regularly and engages in strong collaboration with the Department of Risk and Disaster Management (DRDM) (p. 7). ⁴¹

The Seychelles National Integrated Emergency Management Plan (NIEMP), approved in 2019, further solidifies the multi-sectoral approach to managing various hazards, including "health and sanitary events like epidemics, pandemics, and animal-related diseases" (p. 4). The NIEMP's national priority goals include reducing health impacts, thereby encompassing zoonotic disease concerns (p. 4). This plan establishes an Integrated Emergency Management System (IEMS) that mandates collaboration across all levels of government, non-governmental organizations, and the private sector to prepare for, respond to, and mitigate the effects of incidents (p. 21). The DRDM leads this overall framework for emergency management (p. 20). ⁴²

Under the NIEMP's institutional framework, a National Resilience Platform and Regional Resilience Platforms are proposed to support interagency coordination for emergency preparedness and response. These platforms include organizations designated as Category 1 and Category 2 responders, which involve key ministries and agencies relevant to zoonotic disease. Category 1 responders include the Public Health Authority and the Health Care Agency, while Category 2 responders include the Ministry of Environment, Energy and Climate Change – Department of Environment, and the National Biosecurity Agency (p. 23). The NIEMP outlines specific functional areas for emergency response, one of which is "Health." Within this functional area, tasks related to epidemiological surveillance are led by the Public Health Authority, with supporting roles from the Health Care Agency, National Biosecurity Agency, Seychelles Police Force, and Department of Tourism (p. 45). Similarly, for environmental health, the Public Health Authority is the lead, supported by the Health Care Agency, MOECC, National Biosecurity Agency, Seychelles Police Force, and the Ministry of Habitat, Infrastructure and Land Transport (p. 45, Table A1.2). ⁴³ These detailed roles within the NIEMP's functional areas demonstrate an established multi-sectoral coordination for aspects relevant to zoonotic diseases.

However, the Joint External Evaluation report from March 2018 also indicated a need for further formalization, noting that multi-sectoral collaboration between human, animal, and environmental health sectors for zoonotic events was not yet formalized and streamlined (p. 13). ⁴⁴ In response, the National Health Strategic Plan 2022-2026, published in June 2022, sets a specific objective to "Strengthen the One Health approach" under its "Improve Health Security" strategic direction. A key intervention is to "Establish coordination mechanism for One Health approach," with a milestone being the "National One Health Coordination Committee established," along with formalized processes to guide communication between animal and human health sectors (p. 58). ⁴⁵ This indicates a strategic commitment to further enhance and formalize this multi-sectoral coordination. The Annual Health Sector Performance Report 2023, published in July 2024, generally references multi-stakeholder and inter-sectoral collaborations and mentions Seychelles' participation in regional surveillance platforms like Réseau SEGA, which includes "One Health" networks (p. 14, 37). ⁴⁶

1.2.1e Presence of One Health strategic plan

Score: 0

While there is no evidence of a standalone One Health strategic plan in Seychelles, the One Health approach is a strategic priority in the National Health Strategic Plan 2022-2026.⁴⁷

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

Score: 0

Seychelles has legal reporting requirements, but lacks evidence of a functional national reporting mechanism for livestock owners to submit disease surveillance information.

According to the Public Health Act 2015, specifically Part XI – Prohibition of Certain Activities, Section 56: Obligation to report sickness of animals (p. 56) states: "(1) A person who becomes aware of any unusual sickness or mortality among animals, in particular poultry, fish, dogs, cats, cattle or rodents, shall forthwith report the fact to the Commissioner, an officer, veterinary officer or a police officer." This clearly places a mandatory reporting duty on anyone, including livestock owners, who becomes aware of unusual sickness or mortality in animals. The report is to be made to specified officials: the Public Health Commissioner (the central authority for public health), an officer (Public Health Officer), a veterinary officer, or a police officer. Subsection (2) of the same section then mandates that: "(2) The officer, veterinary officer or police officer, who receives a report under subsection (1), shall forthwith communicate the substance of the report to the Commissioner." ⁴⁸

Furthermore, Part VIII – Prevention and Control of Infectious Diseases, Section 25: Reporting of possible public health emergency (p. 25) also includes livestock owners in its mandatory reporting requirements: "(3) A veterinarian, livestock owner, veterinary director or other person having the care of animals shall report animals having or suspected of having any diseases or conditions that may be potential causes or indication of a public health emergency." ⁴⁹

Despite this clear legal framework, other documents indicate that the practical implementation and effectiveness of this system have faced challenges. The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018 highlighted that while the Public Health Act makes provisions for mandatory reporting, the animal health surveillance system was "not well established," lacking a "clear structure, inadequate manpower and limited funding" (p. 13). The report also explicitly stated that "the animal health reporting system also needs to be tested" (p. 29). ⁵⁰

Recognizing these gaps, the National Health Strategic Plan 2022-2026, published in June 2022, includes strategic objectives to strengthen the "One Health approach" and implement Integrated Disease Surveillance and Response (IDSR). Key interventions under this plan include rolling out IDSR training to animal health staff and formalizing communication mechanisms between animal and human health sectors (p. 58). ⁵¹

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

Score: 0

Legislation in Seychelles, specifically the Data Protection Act 2023, includes provisions designed to safeguard the confidentiality of information, particularly when that information qualifies as "personal data" related to individuals. However, there is no evidence that confidentiality protections are explicitly applied to information collected through livestock disease surveillance or that animal-health reporting systems incorporate data privacy controls for livestock owners.

This Act defines "personal data" as "any information relating to an identified or identifiable natural person" (p.633). The Act explicitly states in Part III, Data Protection, Section 20.(2) that "Personal data processed under this Act shall be confidential and shall not be disclosed in any manner that contravenes this Act" (p.646). Furthermore, data controllers and data processors, who are responsible for handling personal data, are obligated to "implement technical, organisational and physical measures to manage security risks arising from the processing of personal data" (p.646, Section 20.(1)). A data controller is also held accountable for personal data in its possession or under its control, as outlined in Part VI, Safe custody, Section 33.(1) (p.656). They are also required to make their data processing activities transparent through a privacy policy (p.656, Section 34.(1)). ⁵²

The rights granted to data subjects in Part V of the Act further reinforce the protection of their personal data (p.649). These rights include the right to be informed about the processing of their data (p.650, Section 26.(1)), the right to access data held by a data controller (p.651, Section 27.(1)), the right to request rectification or correction of inaccurate data (p.653, Section 28.(1)), and the right to cancel or delete their data under specified circumstances (p.653, Section 29.(1)). ⁵³ However, no evidence was identified showing that this law specifically regulates the confidentiality of animal health surveillance data submitted by livestock owners.

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

Seychelles does conduct surveillance activities related to zoonotic diseases in animals, insects, and other disease vectors, though the extent and formality of these activities vary across sectors. Legislation mandates reporting of animal sickness, and some diagnostic work is undertaken, but comprehensive, well-established surveillance specifically within the animal health sector faces challenges.

The Public Health Act 2015 explicitly places an "Obligation to report sickness of animals," stating that "A person who becomes aware of any unusual sickness or mortality among animals, in particular poultry, fish, dogs, cats, cattle or rodents, shall forthwith report the fact to the Commissioner, an officer, veterinary officer or a police officer" (p. 174). Upon receipt of such a report, the Commissioner is required to "cause the matter to be investigated and take necessary action" (p. 174). This legal framework establishes a basis for passive surveillance in livestock and other animals, including livestock (cattle) and certain wildlife (rodents), by requiring public reporting of unusual disease events. Additionally, Section 25 of the same Act requires that "A veterinarian, livestock owner, veterinary director or other person having the care of animals shall report animals having or suspected of having any diseases or conditions that may be potential causes or indication of a public health emergency" (p. 162). The Act also empowers the Commissioner to order the destruction of any animal or animal produce considered a source of transmission for an infectious disease (p. 166). Furthermore, Part IV of the Act addresses the "Extirpation of Disease Vectors, Pests and Vermins," obliging property owners to keep their land free from conditions conducive to infestation by rats, mice, mosquitoes, insects, or other vermin, and empowering the Commissioner to mandate measures for their elimination and the destruction of breeding places (p. 148). ⁵⁴ This indicates a legislative basis for vector control, a component of surveillance for zoonotic diseases.

However, despite these legal provisions, the Joint External Evaluation (JEE) in 2018 identified significant gaps. It stated that "in the animal health sector, however, the surveillance system is not well established" (p.13). While acknowledging that "The public health sector has a functioning surveillance system for detecting and reporting zoonotic diseases through the IDSR" (p.13), this primarily pertains to human cases. The JEE noted that "Zoonotic disease reporting is weak in both human and animal surveillance systems, and the situation in the animal health sector needs special attention" (p.15). The document mentioned that "Mobile phone technology is being introduced for reporting animal diseases" (p.14), indicating efforts to improve the system. It also stated that the Seychelles Public Health Laboratory (SPHL) "carries out diagnosis of zoonotic infections for the veterinary public health services" (p.24), confirming that actual diagnostic testing on animal samples for zoonotic diseases is conducted, covering livestock and poultry managed by veterinary services, and that "investment in developing veterinary laboratory infrastructure is ongoing, and a new facility is nearing commissioning" (p.24). A "provisional list exists that names seven priority zoonotic diseases of public health importance" (p.14), signaling recognition of specific threats. ⁵⁵

The National Health Strategic Plan 2022-2026 (NHSP) emphasizes future strengthening of these capacities. It states that "The One Health approach… is yet to be well understood and appreciated by the different sectors" (p.55), highlighting a current weakness in multisectoral collaboration for zoonotic surveillance. Strategic objectives include "Strengthen the One Health approach" and "Implement the IHR to prevent, and swiftly detect and manage disease outbreaks," with interventions such as establishing a "National One Health Coordination Committee" and strengthening "disease surveillance and response" (p.58). The NHSP also notes that the rollout of revised Integrated Disease Surveillance and Response (IDSR) Technical Guidelines, which "will support the implementation of a robust disease surveillance system for early detection of outbreaks and swift response," was delayed but planned (p.56). ⁵⁶ This indicates an intention to improve the system, suggesting current limitations. The NHSP 2022-2026 is a strategic document outlining future goals and directions, rather than a report on currently conducted operational activities. While it strongly emphasizes the importance of addressing zoonotic diseases through a "One Health approach" and plans to strengthen surveillance capacities, it does not present specific evidence of currently conducting surveillance in wildlife, poultry, and livestock.

The 2023 Annual Health Sector Performance Report indicates ongoing activities, particularly concerning vectors and human cases of zoonotic diseases. It notes the "ongoing development of a national vector control plan to further prevent the transmission of vector-borne disease", which typically involves surveillance of insect vectors (p.37). Public health officers inspect international conveyances, including "sea vessels and aeroplanes for public health risks, including sick passengers/crew and invasive species" (p.37), which can include disease vectors or wild animals. The report indicates that "Disease investigations for reported cases of certain notifiable conditions were undertaken: 254 for dengue, 4 for leptospirosis, in 2023" (p.37). Both dengue and leptospirosis are vector-borne or zoonotic diseases. While these investigations would typically involve tracing the source, the report primarily details human cases and reactive investigations rather than proactive, systematic animal surveillance (p.37). It also highlights that Seychelles "participated in the regional surveillance platform (Réseau SEGA), where the surveillance roles are being expanded to include climate-sensitive diseases, health risks and conditions, including their forecasting and development of early warning systems" (p.36). ⁵⁷

No events or outbreaks are reported by Seychelles on the website of the World Organisation for Animal Health. ⁵⁸

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), formerly known as OIE.

The OIE PVS Evaluation Report for Seychelles from July 2011 explicitly notes that the Veterinary Services (VS) fulfill their reporting responsibilities to the OIE. Under "Main strengths" for "Access to markets," it states that "A focal point for disease reporting has been nominated and has attended OIE workshops" and "The VS meet their disease reporting obligations to the OIE" (p.8). This is further confirmed in the "Transparency" section, where findings state that "The SVS declarations to the OIE, as reflected through the OIE website, are in conformity with the information collected during the PVS mission" and reiterate that "A focal point for disease reporting has been nominated and has attended OIE workshops" and "The VS meet their disease reporting obligations to the OIE" (p.114). The report also concludes that "Disease reporting to the OIE reflects the country situation" (p.114). ⁵⁹

Further evidence is provided by the Joint External Evaluation (JEE) mission report for Seychelles, conducted in March 2018. It explicitly states that "Seychelles also has a designated OIE contact person who has been trained, with support from FAO/OIE, on reporting procedures" (p.15). This is reiterated in the Indicators and Scores section, which mentions that "An OIE delegate is in place and has undergone training with the FAO and OIE" (p.16). The JEE also highlights that "the national focal person for the World Organization for Animal Health (OIE) collects and submits public sector data on the quantities and usage patterns of antimicrobial agents in animals" (p.10). ⁶⁰

No relevant evidence was found on the website of the WOAH. ⁶¹

1.2.4a Number of veterinarians per 100,000 people

Score: 16.06

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

Score: 10.8

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

Score: 0

While the Public Health Act 2015 mandates reporting of unusual sickness or mortality among animals, which applies to private veterinarians and animal owners, publicly available evidence of explicit national plans or legislation detailing specific mechanisms for working with the private sector in controlling or responding to zoonoses is limited. This suggests that formalized collaborative frameworks beyond reporting obligations are not well-established. ⁶²

The Joint External Evaluation (JEE) in 2018 highlighted weaknesses in this area, stating that "Despite efforts to improve the required capacities for the management of zoonotic diseases, collaboration among the various health sectors (human, animal and environment health) remains weak" (p.14). It further clarified that "There is no formalized and streamlined multi-sectoral collaboration for surveillance and response to zoonotic events, and this hinders effective, rapid management of such events" (p.14). While the JEE mentioned that "Surveillance stakeholders include private facilities, the SPHL, veterinary services and the community at large" (p.26), this is a general statement about involvement rather than a description of established mechanisms for collaboration in zoonotic control. The JEE's recommendations also pointed to a future need, suggesting to "Establish a national One Health coordination committee" (p.14) and noting that "New regulations are needed to strengthen weekly reporting by private facilities" (p.27), which implies current deficiencies in private sector engagement for reporting. ⁶³

The National Health Strategic Plan 2022-2026 (NHSP) acknowledges the need for stronger partnerships. It identifies that the "One Health approach, which promotes multi-stakeholder collaboration to achieve better public health outcomes, is yet to be well understood and appreciated by the different sectors" (p.55). The NHSP sets out to "build strong partnerships with non-health sectors to prevent effectively detect, prevent and respond to zoonosis and food safety problems" (p.55), outlining future strategic directions. Specifically, under Strategic Direction 3 (SD3) to "Improve Health Security," one of the objectives is to "Strengthen the One Health approach" (p.58). The milestones for this objective include establishing a "National One Health Coordination Committee" with clear Terms of Reference and formalizing processes for communication between public animal health and human health sectors (p.58). While the private sector is a stakeholder, these milestones do not explicitly detail mechanisms for private sector collaboration in zoonotic disease control or response, primarily focusing on public sector coordination. The NHSP also broadly aims to "Improve collaboration with private health sector and health-related NGOs" under SD2 (p.53), but this is mainly in the context of broader health service delivery rather than specific zoonotic control. ⁶⁴

The OIE PVS Evaluation Report from 2011, while predating more recent strategic documents, indicates that the private veterinary sector was very small at the time, with "currently only one private veterinary practitioner" (p. 2, 19). Therefore, extensive formal mechanisms for private sector engagement in zoonotic disease control would likely not have been developed. The report mentioned future considerations for "privatisation of clinical activities" and the need for mechanisms for "registration and regulation of these veterinary professionals" if the private sector grew (p. 4, 9), but these are not current or specific zoonotic control mechanisms. ⁶⁵

The Annual Health Sector Performance Report 2023 does not detail specific mechanisms for private sector collaboration in zoonotic disease control or response but focuses on public sector capacity building, such as training of trainers on Integrated Disease Surveillance and Response (IDSR) and participation in regional surveillance platforms (p.14-15). ⁶⁶

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

Score: 0

There is no public evidence indicating that Seychelles has a record, updated within the past five years, of facilities storing or processing especially dangerous pathogens and toxins, nor details on their inventories and inventory management systems. In fact, the available information suggests the opposite.

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018 directly addresses this point. Under the section on Biosafety and Biosecurity, it explicitly states a key finding: "No laboratories in Seychelles are storing dangerous pathogens other than ATCC quality control strains" (p. 19). Furthermore, under "Areas that need strengthening, and challenges" for the whole-of-government biosafety and biosecurity system, the report unambiguously states: "There is no inventory of pathogens kept in Seychelles laboratories" (p. 20). This is a direct answer to the user's question, indicating that not only are dangerous pathogens generally not stored (beyond quality control strains), but also that a comprehensive inventory of any pathogens that might be present is lacking. ⁶⁷

While other documents such as the National Health Strategic Plan 2022-2026 discuss improving data for impact and investing in health information systems, and mentions "Facility specific health technology inventories" (p. 76, 83), these refer to medical equipment and general health data rather than a specific inventory of dangerous pathogens or toxins. ⁶⁸ Similarly, the Infection Prevention and Control 5-Year Strategic Framework 2021-2025 focuses on infection prevention and control practices within healthcare settings and does not outline any system for tracking dangerous pathogen inventories (p. 5-11, 17-23). ⁶⁹

Seychelles's BWC Confidence Building Measures reports are not publicly available. ⁷⁰

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ⁷¹⁷²⁷³

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

Seychelles has border-focused biosecurity legislation addressing containment of imported biological risks but does not have legislation or regulations governing the secure handling, storage, or internal oversight of especially dangerous human pathogens or toxins inside laboratory facilities.

The Animal and Plant Biosecurity Act 2014 is the primary legislative framework, defining "biosecurity" as a strategic and integrated approach encompassing the policy and regulatory framework for analyzing and managing relevant risks to animal and plant life, and the associated risks to the environment, economy, and public health (p. 255). This Act allows for the designation of "biosecurity approved premises" for inspection, testing, and treatment of regulated articles (p. 255). It also provides for "biosecurity quarantine stations" (p. 260), which are facilities "under the control of the Director" designated for performing biosecurity quarantine (p. 260). The Act mandates that these stations must be equipped with buildings and facilities to "hold regulated articles in biosecurity quarantine" and "to prevent unauthorised persons from entering the station or removing items from the station" (p. 339-341), directly addressing physical containment. Furthermore, a biosecurity officer can "lock, seal or otherwise prevent entry to and exit from a biosecurity quarantine station or any building in it" (p. 340), indicating robust physical control. However, there are no provisions in the Act establishing facility-level biosafety or biosecurity requirements (e.g., physical containment levels, laboratory operational practices, inventory controls, failure reporting systems, or cybersecurity measures) for institutions handling dangerous human pathogens or toxins. No sections of the Act reference human infectious disease laboratories, toxins, or high-containment facility standards. ⁷⁴

The Biosecurity Operational Manual, Version 4.0 from December 2011, outlines procedures for regulating the introduction of animals, plants, and related material to reduce the risk of entry and spread of pests, diseases, and Invasive Alien Species (IAS) (p. 1). While the manual details inspection, testing, and treatment procedures for pests (p. 5), and extensively covers the inspection of various items and animals, it focuses on the prevention of entry of biological risks, rather than the internal security of high-containment facilities storing or processing dangerous pathogens or toxins already within the country. For example, it includes standard operating procedures (SOPs) for the inspection of live animals (domestic and companion), animal products, and biological products (p. 6-7). ⁷⁵

The Joint External Evaluation (JEE) report, from March 2018, while acknowledging the Animal and Plant Biosecurity Act 2014 as the legal foundation for biosecurity, points out that "While elements addressing biosecurity are present in various acts, there is no comprehensive national system to ensure pathogens are secure" (p. 20). It recommended implementing a policy framework that includes "measures for management and monitoring of an inventory of dangerous pathogens" (p. 19). This indicates that as of 2018, there was still a recognized gap in a comprehensive, clearly defined legislative or regulatory framework specifically addressing the security (biosecurity) of facilities handling especially dangerous pathogens and toxins in terms of failure reporting systems or cybersecurity. The existing legislation and operational manual focus more on border control and quarantine for imported biological risks. ⁷⁶

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is insufficient evidence that Seychelles has established agencies responsible for the enforcement of biosecurity legislation and regulations.

The primary legislation, the Animal and Plant Biosecurity Act 2014, grants the President the authority to "designate a statutory or governmental body, authority or agency to be the agency responsible for biosecurity" (p. 271). This designated agency is then explicitly "responsible for the implementation and enforcement of this Act" (p. 272). The functions of this agency include regulating the entry of regulated pests and diseases, carrying out surveillance, preventing their establishment and spread, and facilitating the safe importation and exportation of animals, plants, and related products (p. 272). ⁷⁷ However it is unclear whether this covers oversight for biosecurity more broadly, especially in terms of dangerous pathogens and toxins for human health.

The Biosecurity Operational Manual identifies the Seychelles Agricultural Agency (SAA) as having "the legislative responsibility to maintain the biosecurity integrity of the Seychelles" (p. 15). This manual further provides contact information for the "Plant and Animal Health Services" under the "Seychelles Agricultural Agency" (p. ii). ⁷⁸

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

Score: 0

There is no public evidence indicating that the country has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. Moreover, it is unclear whether the existing legal and institutional framework provides comprehensive oversight for biosecurity risks related to human health.

Based on the Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018, "No laboratories in Seychelles are storing dangerous pathogens other than ATCC quality control strains" (p. 19) and "There is no inventory of pathogens kept in Seychelles laboratories" (p. 20). The report did make a recommendation to "Review the legislation and regulations that address biosafety and biosecurity and implement a policy framework that covers all laboratories. This should include measures for management and monitoring of an inventory of dangerous pathogens" (p. 19). This recommendation points to a need for establishing oversight and inventory management where none existed, rather than actively consolidating from numerous existing facilities. ⁷⁹

Subsequent reviews, such as the National Health Strategic Plan 2022-2026 and the Annual Health Sector Performance Report 2023, do not provide any public evidence of efforts to consolidate inventories, including active steps to reduce the number of facilities permitted to hold pathogens, or the establishment of a comprehensive inventory system that would precede such consolidation. ⁸⁰⁸¹ The Annual Health Sector Performance Report, 2023, for instance, focuses on broader health security concerns and laboratory activities without mentioning specific pathogen consolidation initiatives (p. 32-39). ⁸²

Seychelles's BWC Confidence Building Measures reports are not publicly available. ⁸³

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

Score: 100

There is public evidence indicating in-country capacity to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for dangerous pathogens, which would preclude culturing a live pathogen.

The Annual Health Sector Performance Report 2023 mentions that diagnostic kits for Ebola were provided (p. 15). This report also highlights that the Seychelles Public Health Laboratory (SPHL) undertook "Molecular diagnostics" with 9,571 tests performed, indicating a significant PCR capability (p. 39). Furthermore, the report notes that "viral load testing" for HIV, a PCR-based method, is conducted (p. 60). The SPHL also conducted sequencing of COVID-19 samples, a process often initiated with PCR, to identify circulating strains (p. 38). ⁸⁴

Further public evidence from a news report by the WHO Regional Office for Africa, titled "Seychelles launches in-country genomic surveillance" dated 21 March 2022, explicitly states that the WHO and Africa CDC joint initiative, launched in March 2022, established in-country genomic surveillance capacity in Seychelles. As part of this effort, SPHL received a sequencing machine from Africa CDC, along with onsite technical support for installation and operation. This investment has allowed Seychelles to detect SARS-CoV-2 variants and strengthen outbreak investigation capacity. At the launch, the Public Health Commissioner emphasized that genomic sequencing was previously reliant on overseas reference laboratories, but with this equipment and training, results are now generated locally, accelerating public health decision-making. Furthermore, the WHO reported that all 21 SPHL staff, along with additional clinical and private laboratory personnel, were trained in PCR-based COVID-19 diagnostics, demonstrating a strong foundation in molecular methods. ⁸⁵

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no explicit public evidence stating that Seychelles requires biosecurity training, using a standardized approach such as a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential, nor is there mention of recertification at least every five years.

The Animal and Plant Biosecurity Act 2014 mandates that a person designated as a biosecurity officer must receive "adequate training in biosecurity control measures and in the provisions of this Act before discharging those duties" (p. 291). This training is for biosecurity officers primarily involved in border control and preventing the entry and spread of pests and diseases in animals and plants. It does not explicitly cover specialized biosecurity training for personnel handling dangerous human pathogens or toxins in dedicated facilities. ⁸⁶

Similarly, the Biosecurity Operational Manual (December 2011) outlines procedures for biosecurity inspectors, predominantly at points of entry, to manage risks from animals, plants, and related materials (p. 1, 5). While it mentions training for postal workers on "biosecurity issues" (p. 92), this context relates to the screening of mail for regulated articles rather than the security of high-containment laboratories. ⁸⁷

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report (March 2018) identifies a clear gap in this area. While acknowledging that "All laboratory staff are trained in biosafety" with some refresher training (p. 19), the report notes that this primarily concerns biosafety (preventing accidental exposure) rather than biosecurity (preventing intentional misuse). Critically, under "Areas that need strengthening," the report recommends that "A training programme is required that includes refresher training and a train-the-trainers programme… This should cover both biosafety and biosecurity for public health and clinical laboratories, as well as animal laboratories when such facilities are commissioned" (p. 20). This recommendation indicates that such a comprehensive and standardized biosecurity training program for relevant laboratories was a recognized need as of 2018, implying it was not yet fully implemented. The report does not specify any existing recertification schedule. ⁸⁸

More recent documents, such as the National Health Strategic Plan 2022-2026 and the Annual Health Sector Performance Report 2023, discuss broad human resource development, capacity building, and general training for health workers, including in Infection Prevention and Control (IPC). ⁸⁹⁹⁰ However, these reports do not provide specific details on a mandated, standardized biosecurity training program with a re-certification cycle specifically tailored for personnel working with especially dangerous human pathogens, toxins, or biological materials with pandemic potential, which would address the prevention of their theft, misuse, or intentional release.

The Infection Prevention and Control 5-Year Strategic Framework 2021-2025 primarily focuses on Infection Prevention and Control (IPC), which largely aligns with biosafety principles (preventing accidental exposure and spread of infections) rather than biosecurity (preventing intentional misuse or theft of dangerous pathogens and toxins). While this document emphasizes extensive training for healthcare workers (HCWs) in IPC, including on standard and transmission-based precautions, hand hygiene, and the use of Personal Protective Equipment (PPE) (p. 18-19, 28-32), it does not explicitly outline requirements for biosecurity training specifically for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. ⁹¹

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

Score: 0

There is no public evidence to indicate that regulations or licensing conditions in Seychelles specify drug testing, background checks, and psychological or mental fitness checks for security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report (March 2018) explicitly states that "No laboratories in Seychelles are storing dangerous pathogens other than ATCC quality control strains" (p. 19). If such materials are not being stored, the specific regulations for personnel accessing them would likely not be in place. The JEE report, while not directly addressing personnel checks, did recommend a policy framework that includes "measures for management and monitoring of an inventory of dangerous pathogens" (p. 19), implying that the comprehensive control over such materials was an area needing development as of 2018. ⁹²

The Animal and Plant Biosecurity Act 2014 and the Biosecurity Operational Manual (December 2011) primarily focus on preventing the introduction and spread of pests and diseases affecting animals and plants through border control and quarantine measures. While they outline responsibilities for biosecurity officers and their training in general biosecurity control, they do not delve into personnel screening requirements like drug testing, background checks, or psychological evaluations for individuals with access to dangerous human pathogens or toxins within specialized facilities. ⁹³⁹⁴

The National Health Strategic Plan 2022-2026 and the Infection Prevention and Control 5-Year Strategic Framework 2021-2025 are comprehensive planning documents for the health sector. They address human resource management, staff welfare, occupational health and safety, and extensive training in infection prevention and control (biosafety). However, these documents do not detail specific security screening protocols (drug testing, background checks, psychological fitness) for personnel with access to highly dangerous biological materials from a biosecurity perspective. While the National Health Strategic Plan acknowledges issues like substance abuse among healthcare workers (p. 71), it does not connect this to mandatory screening for security access to high-risk materials. ⁹⁵⁹⁶

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

Score: 0

Publicly accessible information specifically detailing national regulations on the safe and secure transport of infectious substances, including the internationally recognized Categories A and B, is not available.

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018 offers the most pertinent insights into the country's practices regarding the movement of biological materials. It notes that an organized system exists for the referral of specimens from clinics and hospitals, leveraging efficient communication and transportation links via boat, sea, and road. Furthermore, staff within the public health system are reported to apply international best practices for the routine international shipment of specimens (p. 24). This suggests an awareness and utilization of established international standards when engaging in cross-border transport. ⁹⁷

However, the same report identifies a crucial area for improvement, indicating that "The standardization of national processes, procedures and infrastructure that is currently applied to international shipments should also be applied to intra-national shipments." It explicitly recommends a priority action to "Standardize specimen transport mechanisms to meet international best practice" (p. 24). This recommendation is a strong indicator that a comprehensive, formalized, and publicly available set of national regulations governing the safe and secure transport of infectious substances for all movements, especially within the country, and clearly delineating categories like A and B, was either absent or not fully harmonized at the time of the evaluation. The emphasis on standardization points to a need to develop or consolidate such a regulatory framework nationally. ⁹⁸

Other key documents further support this conclusion through their silence on this specific matter. The National Health Strategic Plan 2022-2026, while detailing broad health security goals, governance, and investment in health systems and technologies, does not provide granular information on specific regulations for the transport of infectious substances (p. 55-59, 69-77). ⁹⁹ Similarly, the Infection Prevention and Control 5-Year Strategic Framework 2021-2025 extensively addresses biosafety within healthcare facilities, focusing on preventing healthcare-associated infections and managing outbreaks, but it does not delve into the regulatory aspects of safely and securely transporting highly infectious materials between different locations (p. 5-11, 17-23). ¹⁰⁰ The Animal and Plant Biosecurity Act 2014 (p. 273, 303-305) and the Biosecurity Operational Manual (p. 1, 83-84), while laying out extensive biosecurity controls for animals, plants, and related products, do not extend their scope to cover the transport of human infectious substances, Categories A and B. ¹⁰¹¹⁰²

The Public Health Act 2015 provides a foundational legal framework but does not delve into the specifics of transporting infectious substances by categorization. It grants the Minister the power to make regulations for the "prevention of introduction of infectious diseases" which may include conditions for the "importation into Seychelles of any animal, food or article" and "examination, disinfection and detention of food, articles or things imported into Seychelles" (Section 26, p. 163). The Act also addresses the transport of "bedding, clothing, rags or articles which have been exposed to infection from an infectious disease" (Section 35(1)(c)), allowing their transport for disinfection or destruction under Commissioner authorization and proper precautions. Furthermore, it broadly permits regulations for "infections, waste disposal including collection, storage, handling, destruction treatment, transportation and disposal of such waste" ( Section 64(h)). While these provisions allow for control over infected items and infectious waste, they do not constitute specific national regulations detailing the safe and secure transport requirements for infectious substances (such as diagnostic samples or cultures) classified as Categories A or B. ¹⁰³

The Biological Weapons Convention National Implementation Measures Database discusses "Export, import and transfer controls" in a broader sense, referencing the Customs Management Act 2011 for general goods, and the Animal and Plant Biosecurity Act 2014 for "any living organism (whether modified or not), any genetic material and regulated pests and diseases". It also mentions the Civil Aviation (Safety) Regulations 2017 and the Seychelles Civil Aviation Authority Dangerous Goods Directive for "specific requirements for carriers". These laws and directives primarily focus on controlling the movement of certain types of biological materials (e.g., GMOs, animal/plant pathogens) for security or general dangerous goods considerations in air travel. They do not, however, detail specific national regulations for the safe and secure transport of infectious substances (Categories A and B) in terms of packaging, labeling, documentation, or security protocols for all modes of transport within a dedicated public health context. ¹⁰⁴

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

Score: 0

Seychelles has a legal framework that provides some oversight for the cross-border transfer of certain biological materials, but explicit regulations detailing comprehensive end-user screening for all especially dangerous pathogens, toxins, and pathogens with pandemic potential are not clearly articulated in the publicly available documents.

Regarding cross-border transfer, the Biological Weapons Convention National Implementation Measures Database indicates that the Customs Management Act 2011 (Sections 63 and 190) provides rules for the prohibition or restriction of import and export of goods generally. More specifically, the Animal and Plant Biosecurity Act 2014 (Sections 68 and 117-118) mandates a license for the import and clearance for the export of "any living organism (whether modified or not), any genetic material and regulated pests and diseases". ¹⁰⁵ This legislation covers a broad range of biological items that could include dangerous pathogens or biological materials with pandemic potential, and it establishes a licensing or clearance requirement for their cross-border movement. ¹⁰⁶ The First Schedule of the Customs Management (Export Permit) Regulations 2014 also lists "genetically modified organisms as restricted goods, the exportation of which requires a permit". ¹⁰⁷ Additionally, the Public Health Act 2015 grants the Minister authority to introduce regulations for the "restriction or prohibition of the importation into Seychelles of any animal, food or article" to prevent infectious diseases (Section 26). ¹⁰⁸ While these provisions establish a system of control over certain biological imports and exports, they do not universally define "especially dangerous pathogens, toxins" in the specific context of human health, nor do they detail regulations for toxins.

When it comes to end-user screening, the available information is less comprehensive. The Biological Weapons Convention National Implementation Measures Database explicitly states "No information" under the category "End-user certification requirement for export of controlled items". This directly indicates a lack of publicly documented requirements for screening who the final recipient of exported controlled biological materials might be. For imports, while a license or clearance is required, the documents do not detail specific "end-user screening" processes (such as vetting the recipient's facility security, personnel reliability, or specific intended use beyond general permits) for especially dangerous pathogens or toxins. The Health Professionals Act 2006 and the Public Health Authority Act 2013 govern the licensing and registration of health professionals and health-related services, including biomedical laboratories, which would provide some oversight of where such materials might be used domestically, but this is distinct from cross-border end-user screening specific to dangerous pathogens. ^109110111

The Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles report from March 2018 indirectly supports the idea of existing gaps by noting that "While elements addressing biosecurity are present in various acts, there is no comprehensive national system to ensure pathogens are secure" (p. 20). The report's recommendation to "Develop a policy framework that covers all laboratories… [to] include measures for management and monitoring of an inventory of dangerous pathogens" (p. 19) further suggests that a robust system for tracking and controlling such materials, including potentially through end-user screening for transfers, was still in development or lacked formalization at the time. ¹¹²

1.4.1a Biosafety laws/regulations

Score: 0

There is limited national legislation or regulation in Seychelles that specifically addresses biosafety in human laboratory settings to prevent accidental release of harmful biological substances.

The Animal and Plant Biosecurity Act (Act 10 of 2014) was assented to on April 25, 2014, and aims "to prevent the entry of animal and plant pests and diseases into, and their establishment and spread in, Seychelles, to regulate and control the movement of animal and plant pests and diseases and of animals and plants and their products within Seychelles, to facilitate international trade and cooperation in respect of animal and plant pests and diseases and for matters connected therewith and incidental thereto" (p.253). The Act covers "regulated articles" which include "any animal or animal product," "any plant or plant product," "any living organism, whether modified or not," and "any genetic material," among others (p.269). However, these provisions relate to border biosecurity, not laboratory biosafety, and the Act does not include requirements intended to protect workers handling pathogens or to prevent accidental laboratory release. ¹¹³

Complementing this is the Public Health Act (Act 13 of 2015), which provides a broader framework for public health protection. It defines "infectious disease" and "infectious waste," and outlines measures for the "Prevention and Control of Infectious Diseases," including reporting, medical examination, isolation, disinfection, and destruction of sources of infectious disease (p.5-6, p.10-12). However, it is not exclusively a biosafety act. ¹¹⁴

The National Biosafety Framework (NBF), a document from 2005, explicitly addresses biosafety policy in Seychelles, particularly concerning Genetically Modified Organisms (GMOs). It describes itself as "a combination of policy, legal, administrative and technical instruments that have been developed to ensure a high level of protection in the field of transfer, handling and Genetically Modified Organisms resulting from modern Biotechnology" (p.3). Although it refers to a "Biosafety Act (under development)" in 2005, indicating a policy intent for dedicated legislation, it sets out "Seychelles Biosafety Policy on Importation of GMOs or GMO Products" including "Advance Informed Agreement (AIA) procedure" and "Risk Assessment and Risk Management" protocols for GMOs (p.19-20, p.33). The NBF also acknowledges that existing legislation at the time was "inadequate" to cover "new and emerging issues particularly that of Modern Biotechnology" (p.18). It centers on genetically modified organisms (GMOs) and is excluded based on the feedback as it does not regulate laboratory handling of dangerous human pathogens. ¹¹⁵

The Joint External Evaluation (JEE) report from 2018 confirms the existence of this legislative landscape, stating, "Legislation covering biosecurity and biosafety exists under the Animal and Plant Biosecurity Act 2014, the Public Health Act 2014, and the Quarantine Act 1996" (p.20). However, the JEE also critically assesses the comprehensiveness of this framework, noting that "While elements addressing biosecurity are present in various acts, there is no comprehensive national system to ensure pathogens are secure" (p.20). This indicates that while legislation is in place, its integration and scope might not yet fully cover all aspects of biosafety in a consolidated manner, particularly concerning the overarching security of pathogens in general. ¹¹⁶

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

Seychelles has enforcement agencies with mandates for animal/plant biosecurity (NBA) and broader public health regulation (via the Public Health Authority under the Public Health Act). Yet they do not have documented supervision or enforcement mechanisms for laboratory biosafety of dangerous human pathogens and toxins. Therefore enforcement mechanisms exist but do not cover the key laboratory biosafety domain.

The primary agency for biosecurity, particularly in the animal and plant sectors, is the National Biosecurity Agency (NBA). The Animal and Plant Biosecurity Act 2014 (Act 10 of 2014) designates an "Agency" (later identified as the NBA) as the body responsible for the "implementation and enforcement of this Act" (p.272, Section 4(2)). This Act also provides for the designation of "biosecurity officers" who are conferred powers to carry out inspections, searches, seizures, and other enforcement actions related to regulated articles, pests, and diseases (p. 290-291, Sections 26, 30). ¹¹⁷ The Joint External Evaluation (JEE) report from 2018 confirms that "some functions of the animal health sector are under the jurisdiction of the National Biosecurity Agency (NBA), in line with the Animal and Plant Biosecurity Act 2014. These include issuance of import permits for animal source foods, laboratory diagnosis, and border inspections" (p.19). ¹¹⁸

According to the Final Draft National Biosafety Framework, beyond the NBA, the National Biosafety Framework (NBF) outlines a broader administrative system for addressing Genetically Modified Organisms (GMOs), which are central to biosafety. The NBF states that the "Ministry responsible for the portfolio of Environment" (specifically, the Division of Nature and Conservation) acts as the "National Competent Authority for implementing the Cartagena Protocol for Biosafety" and is responsible for "administrative functions required to implement the Biosafety law" (p.27, p.44, Section 9.2, 12.0). This includes overseeing the Biosafety Administration Office, which processes GMO applications and coordinates with other bodies (p.27). ¹¹⁹

Furthermore, the NBF details a multi-agency approach to monitoring and enforcement of biosafety laws, involving several key departments. These include the Department of Finance (Customs Division) for monitoring commodity imports and exports and verifying permits at entry/exit points (p.44). The Department of Environment is responsible for monitoring GMOs in the field (p.44). The Department of Health (Division of Community Health) monitors food safety standards, labeling, and laboratory testing related to GMOs (p.44). The Department of Natural Resources, through its Plant Protection Section, monitors GMOs in agriculture and verifies permits for plant products (p.44). Its Veterinary Section monitors GMOs in livestock and conducts fish inspection (p.44). The Seychelles Bureau of Standard monitors food standards and laboratory standards (p.44). The Department of Finance (Consumer Protection Section) monitors GMOs and GMO products for consumer protection and labeling compliance (p.44). ¹²⁰

The National Health Strategic Plan 2022-2026 (NHSP) further highlights the role of the Public Health Authority (PHA) in regulatory functions related to health security. Under Strategic Direction 3 (SD3) to "Improve Health Security," one objective is to "Strengthen regulatory functions of the PHA," stating that "PHA will regulate, monitor and evaluate all health-related services and ensure that they adhere to good practices in the interest of the public" (p.58, p.95). While general, this mandate would encompass biosafety aspects related to human health and health services. ¹²¹

However, there is no evidence that the NBA (or any agency under the current legislative framework) supervises facilities handling dangerous human pathogens or toxins, or enforces regulations for containment, safety, incident-reporting, or cybersecurity of those facilities. The agencies cited focus on movement of animals/plants/products, invasive species control, and border inspections.

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

Biosafety training is provided for personnel in Seychelles, particularly for laboratory staff. However, available evidence indicates that while initial training occurs, there is a lack of a standardized, required national approach, such as through a common curriculum or a train-the-trainer program, for all personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. The frequency of re-certification for this training is also not specified in the national documents.

The Joint External Evaluation (JEE) report from 2018 notes that "All laboratory staff are trained in biosafety, either during their course at the National Institute of Health and Social Sciences, or outside the country," and that "Some refresher training takes place for established staff" (p.19). This confirms that biosafety training is indeed required and provided. However, the report also highlights a significant gap by recommending to "Implement a national train-the-trainers programme sharing international standards and experiences in biosafety and biosecurity" (p.20). This recommendation implies that such a standardized, national train-the-trainer program was not in place at the time of the evaluation. Further indicating a lack of widespread standardization, the report states that "The National Public Health Laboratory has a draft Biosafety Manual, although this is not replicated in other laboratories" (p.19). ¹²²

The Final Draft National Biosafety Framework, dating from 2005, also refers to a future need for training for inspectorate activities, stating that "Intensive training will be required for the mentioned bodies for inspectorate activities" (p.44), suggesting a recognition of training gaps. ¹²³

1.5.1a Evidence of national assessment of dual-use research

Score: 0

Publicly available evidence does not clearly indicate that Seychelles has conducted a dedicated, proactive assessment to determine all ongoing research occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research across the country.

While the Joint External Evaluation (JEE) report from 2018 notes that "The MOH Research and Ethics Committee approves all research projects, including their biosafety and biosecurity aspects" (p.19), this refers to the review of research submitted for approval. It does not imply a broader, proactive mechanism to identify all such research that might be occurring, particularly if it is not formally submitted, or to systematically identify dual-use research concerns outside the scope of individual project reviews. A significant finding in the JEE that supports the absence of such a comprehensive assessment is the statement that "There is no inventory of pathogens kept in Seychelles laboratories" (p.20). The JEE explicitly recommended addressing this by calling for the implementation of "a policy framework that covers all laboratories. This should include measures for management and monitoring of an inventory of dangerous pathogens" (p.20). The lack of a national pathogen inventory suggests that a systematic assessment of where dangerous biological materials are housed or researched is not yet in place. ¹²⁴

The National Biosafety Framework (NBF) from 2005 discusses risk assessment in the context of specific applications for Genetically Modified Organisms (GMOs), including for research purposes (p.28, p.35). However, this focuses on assessing risks of known GMO applications rather than a broad, national assessment to proactively identify and characterize all ongoing research involving dangerous pathogens or dual-use potential. ¹²⁵

The National Health Strategic Plan 2022-2026 (NHSP), under Strategic Direction 6 "Improve Data for Impact," includes an objective to "Strengthen research capacity" (p.87). Key interventions include establishing a research unit, developing a policy to guide research, identifying priority areas for research, and strengthening the Ethics Committee ( p.88). While these measures aim to improve research governance and capacity, they do not explicitly describe a national assessment mechanism for proactively identifying ongoing research involving especially dangerous pathogens or dual-use potential across various institutions. Identifying "priority areas for research" is about setting an agenda for future research, not assessing all current and potential research for dangerous content. ¹²⁶

The Annual Health Sector Performance Report 2023 mentions a "Research Unit" and lists research projects supported in 2023 (p.39). These listed projects (e.g., Seychelles Child Development Study, colorectal cancer screening, HIV self-test kits) do not appear to involve dangerous pathogens, toxins, or dual-use research. The report also notes that "A number of research projects supported by the research unit were underway in 2023" and describes "Capacity-building on research methods for programme managers" (p.39). However, it does not detail any national assessment conducted to proactively identify all research involving dangerous pathogens or dual-use aspects. It also mentions that "The country also undertook a Strategic (Public Health) Risk Assessment in October 2023" (p.37), but this was an assessment of health threats in general, not an assessment of ongoing research activities for dangerous pathogens or dual-use potential. ¹²⁷

The Biological Weapons Convention National Implementation Measures Database notes that, for Seychelles, there is "No information on the oversight of life sciences dual-use research has been found in publicly available sources". ¹²⁸

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ^129130131

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

Score: 0

There is no identified national legislation or regulation in Seychelles that specifically mandates oversight of research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other forms of dual-use biological research.

The Joint External Evaluation (JEE) report from 2018 provides direct evidence of this oversight mechanism, stating, "The MOH Research and Ethics Committee approves all research projects, including their biosafety and biosecurity aspects" (p.19). This indicates that any research conducted under the purview of the Ministry of Health that involves biological materials, potentially including dangerous pathogens, toxins, or those with pandemic potential, is subject to a review process that specifically addresses biosafety (preventing accidental release) and biosecurity (preventing intentional misuse) concerns. ¹³² The National Health Strategic Plan 2022-2026 (NHSP) further supports the role of this committee by including "Strengthen Ethics Committee" as a key intervention under its objective to strengthen research capacity (p.88). ¹³³ The Annual Health Sector Performance Report 2023 notes that the Research Unit supports various projects and mentions "Capacity-building on research methods," aligning with the continued function of research oversight (p.39). ¹³⁴ However, no legislation was identified.

Furthermore, the National Biosafety Framework (NBF), although a 2005 document, outlines a regulatory structure for Genetically Modified Organisms (GMOs). The NBF describes a comprehensive administrative system involving risk assessment and risk management procedures for GMOs (p.28, p.35). It details a "National Biosafety Board" as the decision-making body for GMOs, which receives inputs and advice from "Biosafety Advisory Bodies" composed of scientific, socio-economic, and ethical experts (p.28-29). This framework explicitly covers GMOs "destined for contained use," which includes research activities (p.23). The NBF states that "Field trials or market introductions into the country will only be permitted if it has been sufficiently shown in a scientific manner that it does not pose any social, economic and ethical threats to the country and its population" (p.39), directly mandating oversight for research (field trials) on these modified biological materials. ¹³⁵ However, GMOs do not count as especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

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

Score: 100

There is an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual-use research in Seychelles. This responsibility primarily falls to the Ministry of Health (MOH) Research and Ethics Committee.

The MOH Research and Ethics Committee is explicitly tasked with this oversight. The Joint External Evaluation (JEE) report from 2018 states unequivocally that "The MOH Research and Ethics Committee approves all research projects, including their biosafety and biosecurity aspects" (p.19). This means that any research submitted for approval under the MOH, which involves biological materials that could be dangerous or have dual-use potential, must undergo review by this committee, considering both the prevention of accidental harm (biosafety) and the prevention of intentional misuse (biosecurity). ¹³⁶ The National Health Strategic Plan 2022-2026 (NHSP) reinforces the importance of this body by including "Strengthen Ethics Committee" as a key intervention to enhance research capacity (p.88). ¹³⁷ The Annual Health Sector Performance Report 2023 also mentions a "Research Unit" and research projects being supported, implying the continued function of this oversight (p.39). ¹³⁸

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

Score: 0

There is no publicly available evidence of specific legislation or regulation in Seychelles requiring the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold.

While the Animal and Plant Biosecurity Act 2014 does include "any genetic material" within its definition of "regulated articles," the context of this Act primarily concerns the importation, movement, and establishment of such materials to prevent the entry and spread of pests and diseases (p.269). It outlines requirements for biosecurity import permits and conditions, focusing on controlling the introduction of biological hazards. It does not explicitly detail a mechanism for pre-sale screening of commercially synthesized DNA fragments against pathogen/toxin lists. ¹³⁹

The National Biosafety Framework (NBF) of 2005 focuses on Genetically Modified Organisms (GMOs) and their products, including procedures for risk assessment and advance informed agreement (AIA) for their transfer and use (p.3, p.19-20). While synthesized DNA is foundational to GMO creation, the NBF's scope centers on the organisms or their direct products, rather than the commercial sale of raw synthesized DNA sequences themselves. ¹⁴⁰

The Joint External Evaluation (JEE) report from 2018 notes a significant gap related to biological materials by stating, "There is no inventory of pathogens kept in Seychelles laboratories" and recommends "measures for management and monitoring of an inventory of dangerous pathogens" (p.20). The absence of such an inventory, which would be crucial for effectively implementing any screening program, further suggests that a specific regulation for screening synthesized DNA prior to sale against pathogen and toxin lists is not currently in place or widely documented. ¹⁴¹

Other documents such as the Public Health Act 2015, National Health Strategic Plan (NHSP) 2022-2026, and Annual Health Sector Performance Report 2023 address general public health, strategic health planning, and health sector performance, respectively, but do not contain provisions related to the screening of synthesized DNA. ^142143144 The Biological Weapons Convention National Implementation Measures Database webpage for Seychelles, which focuses on national implementation measures for the Biological Weapons Convention, similarly does not mention any specific legislation or regulation for the pre-sale screening of synthesized DNA. Its "Prohibitions" section focuses on the prevention of terrorism acts involving biological weapons and toxins, rather than regulating the commercial synthesis and sale of DNA. ¹⁴⁵

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 50

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

Score: 0

Based on the information available through the World Organisation for Animal Health (formely OIE) database for Seychelles, there is no publicly available vaccination data specifically for Foot-and-Mouth Disease for livestock. The dashboard shows control measures related to vaccination prohibited, but current vaccination figures are not displayed for FMD in Seychelles's profile within this database. ¹⁴⁶

1.6.1c Equitablenature of national immunization strategy/plan

Score: 0

Seychelles has a long-established immunization program, embedded within its health strategy, and is in the process of finalizing a dedicated National Immunization Strategy for 2026-2030. The current framework demonstrates strong commitments to equitable distribution and includes strategies that address socioeconomic, cultural, geographic, and gender-related barriers. However, a finalized, standalone national immunization strategy document explicitly detailing all these components is not yet in place.

Firstly, regarding whether there is a national immunization strategy/plan, the news titled "Seychelles paving the way for sustained immunization efforts to 2030" explicitly details a workshop from February 3 to February 7, 2025, conducted to "develop the country's National Immunization Strategy (NIS)" for 2026 to 2030. The workshop progressed to "developing and finalizing the draft narratives of the NIS". ¹⁴⁷ This indicates an active and ongoing process to establish a national strategy. Furthermore, the Annual Health Sector Performance Report 2023 (p.13) states that the Ministry of Health's work is guided by the National Health Strategic Plan (NHSP) 2022-2026, and immunization is a component of the broader health sector goals. ¹⁴⁸ The news on the "Vaccination Week 2023" also notes the launch of a "Revised Life Course Immunisation Schedule" in 2023, described as an "important step and a milestone in the history of immunisation in Seychelles". ¹⁴⁹ The immunization program itself was formally established in 1974. ¹⁵⁰

In addition, the National Health Strategic Plan 2022-2026 (NHSP) embeds immunization within the country’s broader health framework. It includes "Expand utility of vaccination in disease prevention" and "Expand capacity of the Expanded Programme on Immunisation (EPI)" as key interventions under Strategic Direction (SD) 4 (p.67). Immunization coverage is listed as a service coverage indicator, with targets for DPT Dose 3, Penta-/Hexa-valent Vaccine Dose 3, and HPV for girls (p.112). ¹⁵¹ The 2023 Annual Hospital Services Statistical Report also references immunization as a health-related program (p.14). ¹⁵² These references confirm the existence of an ongoing immunization program. However, an explicit, finalized standalone NIS covering 2026-2030 is not yet available.

Secondly, concerning equitable distribution, the development of the NIS is aimed at "ensuring that the Seychelles population is protected against preventable diseases", implying a goal of universal coverage across the population. ¹⁵³ The existing program includes "free and accessible child health services" that ensure "vaccines administered at birth are received in a timely manner". Seychelles has achieved "high vaccination coverage for essential childhood vaccines, reaching above 95%", suggesting effective mechanisms for equitable distribution are already in place. ¹⁵⁴ The Revised Life Course Immunisation Schedule aims to ensure "our population have access to the optimal protection against vaccine preventable infections". ¹⁵⁵

At the strategic level, the NHSP highlights Universal Health Coverage (UHC) as a core goal, stating that UHC means "all people have access to the health services they need, when and where they need them, without financial hardship on them" (p.47). It also includes an explicit objective to "Ensure no one is left behind: Measure and improve equity in access to health services, and health outcomes" (p.49). ¹⁵⁶ While not specific only to immunization, these commitments to equity apply across all health services, including vaccination.

Thirdly, regarding strategies to overcome socioeconomic inequalities, geography, cultural/linguistic differences, and/or gender barriers, the workshop for the NIS development included discussions on engaging "non-traditional immunization stakeholders and other public health actors" to enhance public health outcomes. A key priority identified was "addressing vaccine hesitancy through targeted communication campaigns", which can address cultural or socioeconomic barriers. ¹⁵⁷ The Ministry of Health launched an educational campaign for HPV vaccination that specifically aimed to "raise awareness on the introduction of the vaccine for boys in 2024", directly addressing a gender barrier by expanding access. The plan also includes reducing stigma surrounding HPV and increasing "teachers’ awareness and knowledge of HPV and HPV vaccine", targeting cultural/social barriers. ¹⁵⁸

Socioeconomic and demographic coverage is also highlighted. The Revised Life Course Immunisation Schedule "makes provision for protecting the health of the older members of our community through the pneumococcal vaccine". ¹⁵⁹ Geographical access is being addressed by improvements such as the new Saint Mary’s Hospital on La Digue, which expands services and improves accessibility for the community on that island (p.40). ¹⁶⁰ The Ministry of Health's health workers actively "educate mothers on the importance of immunization from the antenatal clinic appointments, right through birth and postnatal until when the children go to school", reflecting continuous strategies to overcome cultural and knowledge barriers. ¹⁶¹

Within the broader NHSP, additional relevant commitments include the need to "Address discrimination and protect rights of vulnerable population groups" (p.50) and to "Remove communication barriers (doctors who do not speak local languages)" (p.9). Under SD4, the NHSP aims to adopt a "gradient approach across the life course to cater for the needs of different age groups and socioeconomic groups in the population" (p.66). It also emphasizes strengthening "Health Promotion frameworks, resources and supports" (p.68). While these strategies are health-system wide, they demonstrate alignment with addressing barriers relevant to immunization. ¹⁶²

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

Score: 0

There is insufficient evidence that the national immunization strategy and related plans in Seychelles include specific measures to address vaccine hesitancy and build public trust in vaccines.

The development of the National Immunization Strategy (NIS) for 2026-2030 directly addresses these concerns. A workshop held in February 2025, focused on formulating this NIS, identified "addressing vaccine hesitancy through targeted communication campaigns and clear communication on the national immunization programme" as a key priority. This approach aims to foster "greater public understanding and trust in vaccines". ¹⁶³ However, the plan has not yet been published so cannot be assessed appropriately for this indicator.

Furthermore, existing initiatives and documents reinforce this commitment. The "Vaccination Week 2023" news acknowledges that the Ministry of Health faces challenges due to "vaccine hesitancy, inconsistent health education in schools, and the impact of vaccine conspiracy and anti-vaccine movements". In response, a key focus of the 2023 Vaccination Week was an HPV vaccination educational campaign. This campaign aimed to "reinforce existing messages for girls and raise awareness on the introduction of the vaccine for boys in 2024"). Critically, this campaign also explicitly intended to "address some of the circulating misinformation and disinformation around the vaccine, thereby fostering greater confidence in its safety and effectiveness". Planned actions for the coming year include working on "reduction of stigma surrounding HPV" and increasing "teachers’ awareness and knowledge of HPV and HPV vaccine", all of which contribute to building trust and countering hesitancy. ¹⁶⁴

While not exclusively focused on immunization, the "National Health Strategic Plan 2022-2026" (NHSP) emphasizes broader strategies relevant to public trust. Under Strategic Direction 1, "Strengthen Leadership, Governance and Administration," a key intervention is to "Develop and implement effective communication strategies" (p.44). This overarching goal would encompass efforts to communicate about immunization. Strategic Direction 4, "Promote Healthy Populations," includes equipping people to "better take care of their health" by developing and implementing a "health literacy project" (p.68). Improved health literacy is fundamental for informed decision-making regarding vaccination and building trust. The NHSP also acknowledges "vaccine scepticism" as a challenge that can impact the success of health interventions (p.99), demonstrating an awareness of the issue at a strategic level. ¹⁶⁵

The Communications Strategy for Plague Preparedness and Response 2017 provides a precedent for public health communication campaigns designed to build trust. Its guiding principles, such as "build trust," "be transparent," "respect public concerns," and "rumour management" (p.12), establish a framework for addressing public concerns and building confidence that would be transferable to immunization efforts. This document also highlights the use of "targeted communication campaigns" (p.19) and various media channels to disseminate information and counter misinformation (p.22). ¹⁶⁶

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Seychelles formally incorporates expert advice and technical guidance in the formulation and revision of its immunization strategies and plans through a national advisory group.

The existence and function of such a group are directly evidenced by its role in developing the Revised Life Course Immunisation Schedule, launched in 2023. This schedule, an important milestone in the history of immunization in Seychelles, was notably "guided by evidence-based recommendations from WHO and a national advisory group". This statement confirms that an established body of experts provides crucial input, ensuring that the country's immunization practices align with global best practices and local health needs. ¹⁶⁷

Furthermore, the broader health system in Seychelles demonstrates a consistent practice of relying on expert committees and technical groups for strategic planning and implementation. For instance, the Infection Prevention and Control Strategic Framework 2021-2025 acknowledges the Infection Prevention and Control Committee (IPCC) and a Technical Working Group (TWG) for their instrumental roles in developing that document (p.2). Their mandates often include reviewing guidelines, planning interventions, and providing oversight (p.25-26). ¹⁶⁸

The National Health Strategic Plan 2022-2026 also highlights the importance of "Professional Councils" in setting and maintaining standards of training and practice for healthcare professionals (p.96). These councils, such as the Seychelles Medical and Dental Council (SMDC), Seychelles Nurses and Midwives Council (SNMC), and Health Professions Council (HPC), play a vital role in ensuring that healthcare workers involved in vaccine administration are competent and adhere to professional standards. The NHSP itself was developed through a participatory approach engaging "Technical Working Groups" (p.V), which further illustrates the government's reliance on expert panels for critical health policy. ¹⁶⁹

While the precise composition and terms of reference for the national immunization advisory group are not detailed in national documents, its explicit mention in the context of significant immunization policy updates confirms its active role.

Moreover, the Seychelles self reported having a NITAG to the WHO.¹⁷⁰

1.6.1f Presence of an immunization programme for influenza

Score: 0

Seychelles does not have an immunization program for influenza.

There is no data available on World Health Organization's Immunization Data portal for Seychelles. ¹⁷¹

The WHO Strategic Preparedness and Response Portal (SPH) notes that for an "Influenza Plan," the status is "No Plan or Plan not publicly available (0 Influenza Plan)". ¹⁷²

The National Health Strategic Plan 2022-2026 (NHSP) in Seychelles underscores the broader commitment to expanding the utility of vaccination in disease prevention and strengthening the Expanded Programme on Immunisation (EPI) (p.67). However, the NHSP does not specifically enumerate influenza as a vaccine-preventable disease with explicit targets in its indicator matrix for immunization coverage (p.112). ¹⁷³

1.7.1a Strategy/plan for resilience of health system

Score: 100

There is evidence that Seychelles has a strategy or plan to develop a health system resilient to the challenges posed by climate change and changing seasonal weather patterns, and this includes considerations that specifically address the threat of infectious diseases.

The National Health Strategic Plan (NHSP) 2022-2026 acknowledges the country's vulnerability to climate change, stating: "As a small island state, Seychelles is also vulnerable to climatic phenomena, especially those associated with rising global temperatures, extreme weather events and rising sea levels" (p. 12). It further emphasizes: "Even though Seychelles is only a minor contributor to climate change, we will bear the brunt of the consequences of climate change, emphasising the importance of elaborate and timely evidence-based mitigation and adaptation strategies, including in the health sector" (p. 62). ¹⁷⁴

The NHSP integrates climate change considerations into its strategic directions. Strategic Direction 2 (SD2) includes "Mitigate risks and mainstream resilience across the health system," and under this, a specific objective is "Climate change mitigation and adaptation in health" (p. 49). Key interventions for this objective include: "Improve awareness of climate impacts on health," "Mainstream climate mitigation and adaptation through climate-informed health system strengthening," and "Develop a Health National Adaptation Plan aligned with National Climate Change Policy" (p. 54). There is also a mention of "Considerations of climate change mainstreamed in plans for health facilities" (p. 54). Under SD5, "Invest for Results," the health sector will "elaborate a comprehensive infrastructure development and management plan to address resilience in the face of climate change" (p. 76). ¹⁷⁵

Regarding the inclusion of infectious diseases, the NHSP explicitly links climate change to the threat of infectious diseases. In the discussion of SD3, "Improve Health Security," it mentions that "Climate change effects, including sea-level rise, coastal erosion, extreme weather events and flooding, hold immediate and long-term threats to health" and points out "Effects on the marine eco-systems will adversely impact food availability and quality and elevate the risk of toxicity" (p. 55). More specifically, when discussing dengue fever, the document states: "Several factors contribute to the increase in dengue infections the country has recorded over the last five years; they include high mosquito density, susceptibility to circulating serotypes, favourable air temperatures, precipitation, and humidity. Although no studies were done recently, these can be linked to change in weather patterns due to climate change" (p. 56). ¹⁷⁶

Furthermore, a "Framework describing how climate change impacts global public health" is included in the document (p. 63), which visually represents the pathways from climate change drivers to population exposures and subsequent health outcomes, implicitly encompassing a range of climate-sensitive health issues including infectious diseases. ¹⁷⁷

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

Score: 50

The national laboratory system in Seychelles demonstrates a substantial capacity for conducting diagnostic tests across a wide range of health conditions, encompassing various WHO-defined areas.

As noted in the Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, the country "provides testing for the majority of WHO diseases, and has developed routine testing capacity for other diseases of public health significance" (p. 24). This broad capability is supported by two primary national reference laboratories: the Seychelles Public Health Laboratory (SPHL) and the Clinical Laboratory (CL), which together form the Seychelles National Laboratory System (p. 23). ¹⁷⁸

The sheer volume of diagnostic work underscores this capacity, with a total of 881,829 tests conducted at the Clinical Laboratory in 2023, according to the Annual Hospital Services Statistical Report (p. 8). These tests are distributed across key departments, including biochemistry (564,319 tests), haematology (222,573 tests), blood transfusion services (50,752 tests), microbiology (34,408 tests), and surgical pathology (9,777 tests) (p. 11). ¹⁷⁹ The Annual Health-sector Performance Report for 2023 also confirms a total of 882,000 laboratory tests performed, indicating a 9% increase over 2022 (p. 53). This significant workload included approximately 20,000 additional tests specifically for the Seychelles Heart Study V (p. 53). ¹⁸⁰

The diagnostic capabilities extend to various critical public health areas. For infectious diseases, the Clinical Laboratory offers rapid testing for conditions like leptospirosis and Dengue fever, which are epidemiologically relevant to the country (p. 24, 25). ¹⁸¹ The SPHL is actively involved in testing for conditions such as HIV, viral hepatitis B and C, syphilis, and tuberculosis, which are noted as persistent public health challenges (p. 5, 32). In 2023, over 19,000 HIV tests were conducted (p. 60), and the introduction of new syphilis testing guidelines in antenatal care led to over 2,115 tests, identifying 17 positive cases among pregnant women (p. 55). The SPHL also conducted serotype testing for Dengue, confirming serotype 1 as the primary circulating strain in 2023, and performed sequencing for COVID-19 samples, identifying Omicron as the prevalent strain (p. 38). ¹⁸²

Furthermore, the national clinical laboratory demonstrates capacity in antimicrobial resistance (AMR) detection, capable of isolating and identifying bacterial agents and testing their susceptibility to antimicrobials using established methods such as disc diffusion, with results interpreted according to CLSI AST (Clinical Laboratory Standards Institute Antimicrobial Sensitivity Test) standards (p. 10). ¹⁸³ Surveillance for multi-drug resistant organisms (MDROs) like Klebsiella pneumoniae, Acinetobacter baumanii, and multi-drug resistant Enterococci species is conducted, and gonococcal resistance patterns are tested (p. 35,36). ¹⁸⁴

In addition to disease diagnostics, the laboratory system provides crucial support for other health services. Post-mortem examinations totaled 289 in 2023, an increase from 172 in 2022 (p. 53). Screening for drugs of abuse for patients in the Methadone substitution program was introduced in 2023, with 95% of urine samples showing poly-drug use (p. 38). Environmental sampling for hospital hygiene monitoring has been expanded to all hospital wards, and increased contamination of water in the environment has been detected through analysis of effluent and seawater samples (p. 38). The SPHL achieved a 4-star rating after a WHO SLIPTA audit, indicating progress toward accreditation, and attained designation as an Environmental Laboratory (p. 38). ¹⁸⁵

Rapid testing for Dengue fever is available, with the SPHL conducting serotype testing in 2023 (JEE, p. 24; Annual Hospital Services Statistical Report, p. 38). Similarly, leptospirosis can be rapidly diagnosed at the Clinical Laboratory (JEE, p. 24). The National Public Health Laboratory also supports tuberculosis detection, including culturing organisms associated with multidrug-resistant TB (JEE, p. 19). HIV diagnostic services remain robust, as evidenced by more than 19,000 tests conducted in 2023 and routine screening among pregnant women (Annual Hospital Services Statistical Report, p. 60, p. 59). Universal screening for Viral Hepatitis B and C in pregnancy and the reporting of new cases further confirm established diagnostic services for these infections (Annual Hospital Services Statistical Report, p. 59, p. 34). Additionally, the system maintains active surveillance for syphilis, having performed more than 2,115 tests in 2023 and introducing updated antenatal care guidelines to strengthen detection (Annual Hospital Services Statistical Report, p. 55). Laboratory capability for antimicrobial resistance (AMR) surveillance is evident through bacterial isolation, identification and susceptibility testing using disc diffusion and CLSI standards, including monitoring for MDROs and gonococcal resistance patterns (JEE, p. 10; Annual Hospital Services Statistical Report, p. 35-36). Moreover, sequencing of COVID-19 samples carried out by the SPHL in 2023 supports ongoing capacity to detect emerging and circulating variants (Annual Hospital Services Statistical Report, p. 38). ¹⁸⁶¹⁸⁷

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

While general public health emergency preparedness and response plans are in place, their explicit focus on the granular details of testing strategy for novel pathogens and scaled capacity is not evident.

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, published in 2018, notes the existence of a "public health emergency preparedness and response plan" that is tested every two years (p. 35). It also mentions that "The Ministry of Health also has disease specific plans, and the pharmacy keeps a 3-6 month stock in case of emergency" (p. 34). However, this report also identified areas needing strengthening in laboratory capacity, stating that "There is a need to increase the quantity and quality of advanced and/or confirmatory testing capacity available in the country" (p. 25). It also highlighted that the "public health emergency contingency plan for responding to emergencies at Seychelles International Airport… does not cover all hazards" (p. 47), indicating potential gaps in comprehensive planning. ¹⁸⁸

The National Health Strategic Plan (NHSP) 2022-2026 identifies "Improve Health Security" as a key goal, aiming to "Prepare, prevent, detect early and respond to all health emergencies" (p. II). Under Strategic Direction 3 (SD3) for Improving Health Security, one of the specific objectives is to "Implement the IHR to prevent, and swiftly detect and manage disease outbreaks," which includes establishing mechanisms for detecting and responding to public health threats and mapping priority public health risks (p. 58). This framework broadly touches upon detection and response but does not specify a detailed testing strategy for novel pathogens or explicit plans for scaling testing capacity. The NHSP also acknowledges that "Maintaining the current parallel governance structure for COVID-19 is not sustainable as it diverts the focus of senior management from other core health system functions" (p. 99), and proposes mitigation strategies such as defining a package of essential services and developing a plan for service continuation during emergencies (p. 102). These points suggest an intent to formalize emergency response, which would implicitly involve testing, but lack explicit details of a testing plan. ¹⁸⁹

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 refers to an "emergency preparedness and readiness plan that includes IPC interventions," and states that this plan "to a large extent addresses roles and functions of different agencies, training, surveillance, logistics, communication and surge capacity" (p. 10). While "surge capacity" could encompass increased testing, the document does not explicitly delineate strategies for scaling testing capacity, defining testing goals, or addressing novel pathogens within such an emergency testing plan. It also suggests that "Available guidelines and SOPs should be reviewed to reflect current knowledge" (p. 10), indicating ongoing development and refinement rather than a fully comprehensive current document. ¹⁹⁰

The Annual Health Sector Performance Report for 2023 indicates that testing activities reverted to normal routines after the COVID-19 pandemic emergency phase ended, with the WHO declaring the end of the Public Health Emergency of International Concern in June 2023 (p. 32). The report mentions sequencing of COVID-19 samples for circulating strains (p. 38), which relates to pathogen characterization, but not a specific plan for future novel pathogens. ¹⁹¹

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

Score: 0

There is insuficient evidence to confirm that a national reference laboratory in Seychelles has achieved accreditation such as International Organization for Standardization (ISO) 15189:2003 or U.S. Clinical Laboratory Improvement Amendments (CLIA).

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, a mission report from March 2018, explicitly states that "There is no accredited laboratory in Seychelles" (p. 25). While the Seychelles Public Health Laboratory (SPHL) "has achieved ISO9001:2008 certification," this is for a quality management system (QMS) and not the specific medical laboratory accreditation (ISO 15189) in question (p. 23, 25). At the time of this 2018 report, both the SPHL and the Clinical Laboratory (CL) "are in the process of achieving accreditation through the WHO-endorsed Strengthening Laboratory Management Toward Accreditation (SLMTA) approach" (p. 25). ¹⁹²

More recent information from the Annual Health Sector Performance Report for 2023, published in July 2024, indicates ongoing progress towards accreditation. This report mentions that "The SPHL received 4-start rating after a WHO SLIPTA audit, with the possibility of paving the way for accreditation in 2024" (p. 38). This implies that as of the end of 2023, accreditation had not yet been finalized, but significant steps were being taken with an anticipation for it in the near future. The SPHL also "attained the designation of an Environmental Laboratory under the Environmental Protection Act" (p. 38), which is a regulatory designation rather than an accreditation like ISO 15189. ¹⁹³

No recent development on the laboratory accreditation was found on the website of the Ministry of Health. ¹⁹⁴

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

Score: 100

The Seychelles Public Health Laboratory (SPHL), which functions as a national reference facility, is subject to external quality assurance review.

The Annual Health Sector Performance Report for 2023 confirms this, stating that "The SPHL received 4-start rating after a WHO SLIPTA audit" (p. 38). This WHO SLIPTA audit is a form of external quality assurance review, indicating an independent assessment of the laboratory's quality systems and performance. The report further elaborates that "The full External Quality Assurance results summary is available in the SPHL Annual Report for 2023" (p. 38), which directly verifies the laboratory's participation in such external reviews. ¹⁹⁵

Earlier, the Joint External Evaluation of IHR Core Capacities of the Republic of Seychelles in 2018 had noted the need for the country to "establish a framework for national external quality assurance and proficiency testing for priority diseases" (p. 23), and mentioned that the SPHL and the Clinical Laboratory were "in the process of achieving accreditation through the WHO-endorsed Strengthening Laboratory Management Toward Accreditation (SLMTA) approach" (p. 25). The recent 2023 performance report confirms progress in this area, specifically with the SPHL undergoing a SLIPTA audit. ¹⁹⁶

Furthermore, the National Health Strategic Plan 2022-2026 includes objectives to "Strengthen national laboratory capacity through updated standard operating procedures, staff training, provision of kits, and participation in regional quality control networks" (p. 16). Participation in such "regional quality control networks" (p. 16) inherently involves external quality assurance, reinforcing the commitment to ongoing external oversight of laboratory performance. ¹⁹⁷

2.2.1a Nationwide specimen transport system

Score: 100

There is a nationwide specimen transport system in Seychelles.

The WHO IHR State Party Annual Report (SPAR) for Seychelles, 2024, indicates a score of 100 for the C.5.1 Specimen referral and transport system. A score of 100 in this context signifies the highest possible level of achievement and capability within the International Health Regulations (IHR) framework for this specific indicator. This high score quantitatively confirms the existence and robustness of a comprehensive, nationwide system for specimen transport. ¹⁹⁸

Further qualitative details describing this system are provided in the Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, a mission report from March 2018. Under the indicator D.1.2 "Specimen referral and transport system," the JEE report explicitly outlines an "organised system in place for referring specimens from clinics, hospitals and private practitioners" (p. 24). This system is described as being "efficient particularly because of good communication and transportation links (boat, sea and road)" (p. 24). ¹⁹⁹

The JEE also confirms the nationwide reach of this system, stating that "Samples are transported to the CL [Clinical Laboratory] from all the health facilities on the three most populated islands (Mahé, Praslin and La Digue)" (p. 23). The report further notes that the "national specimen transportation system is fully funded by the government" (p. 24) and that "Staff within the public health system have been trained in, and apply, international best practice for routine international shipment of specimens" (p. 24). ²⁰⁰

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

Score: 0

There is no explicit mention of a specific plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system for scaling up testing during an outbreak. While national documents acknowledge the presence of private healthcare providers and the intent to strengthen regulatory frameworks, they do not detail a mechanism for rapid authorization of external laboratories for emergency surge capacity.

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles (2018) mentions that the "Ministry of Health is setting up a statutory framework for licensing medical laboratories and medical laboratory practices" (p. 23). However, this refers to a general licensing framework, not specifically a rapid authorization process for outbreak scenarios to scale capacity. It also notes that "private practitioners offer further limited laboratory services" (p. 23). ²⁰¹

The National Health Strategic Plan (NHSP) 2022-2026, under its "Outstanding Issues" for improving health security, highlights that the "private health sector is expanding rapidly… There is a need for strong regulatory instruments and monitoring to ensure that all private health facilities adhere to norms, regulations and good practices. Currently, required legal instruments are either lacking or outdated and cannot respond to the continued development and expansion of the private health sector" (p. 57). This indicates a current deficit in robust regulatory frameworks for the private health sector in general, which would imply the absence of a specialized, rapid authorization plan for emergencies. The NHSP does set an objective to "Strengthen national laboratory capacity" (p. 16), but this refers to internal capacity building rather than supplementing with external, rapidly licensed facilities. ²⁰²

The Annual Health Sector Performance Report for 2023 notes that "New regulations for medical products and pharmacy operations were under development, as were guidelines for health-sector business plans" by the Regulatory Unit (p. 39). This shows ongoing development in regulatory areas, but again, does not specify a rapid authorization plan for laboratories during an outbreak. ²⁰³

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ^204205206

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

Score: 50

There is extensive evidence that Seychelles is conducting ongoing event-based and indicator-based surveillance and analysis for notifiable and novel infectious diseases, but not on a daily basis.

According to the Joint External Evaluation (p. 26) and the Annual Health Sector Performance Report 2023 (p. 38), the country employs the Integrated Disease Surveillance and Response (IDSR) strategy, which incorporates both paper-based and web-based (though recently shifted to Google Forms due to system discontinuation) e-surveillance, sentinel surveillance, and event-based (rumour) surveillance. ²⁰⁷²⁰⁸

An early warning system is in place to detect epidemic-prone diseases and unusual health events, utilizing routine healthcare-based syndromic surveillance for conditions such as influenza-like illness (ILI), severe acute respiratory illness, gastroenteritis, and dengue-like illness (p. 26, 28). Other surveillance initiatives include monitoring fever rash, nosocomial infections, antimicrobial resistance (AMR), and cancer (p. 26). ²⁰⁹

In 2023, the Disease Surveillance and Response Unit (DSRU) reported approximately 6,500 notifiable diseases, with specific disease investigations undertaken for dengue and leptospirosis (p. 37-38). ²¹⁰ The Public Health Act 2015 includes a "Second Schedule" listing "Notifiable Diseases" such as acute flaccid paralysis, cholera, dengue, diphtheria, HIV/AIDS, measles, meningococcal meningitis, plague, rubella, sexually transmitted infections, tetanus, tuberculosis, yellow fever, and zoonotic diseases, for which reporting is compulsory (p. 181-182). ²¹¹ The Annual Health Sector Performance Report 2023 provides a comprehensive list of notifiable conditions reported in 2023, including COVID-19, various hepatitis strains, and sexually transmitted infections (p. 38). ²¹²

Analysis of surveillance data is ongoing, with reports disseminated weekly and thresholds and alert lines derived from the previous five years of data (p. 27-28). ²¹³ The Seychelles Public Health Laboratory (SPHL) conducts advanced analysis relevant to novel pathogens and variants, such as dengue serotype testing and genomic sequencing of COVID-19 strains to identify circulating variants (p. 38). Environmental surveillance, including the testing of effluent water samples and monitoring for Chlorophyll-A, is also conducted, which informs public health on potential contamination (p. 38). ²¹⁴

The country explicitly conducts surveillance for "newly emerging or re-emerging diseases that threaten health security" (p. 56) ²¹⁵ and undertakes Strategic (Public Health) Risk Assessments to identify priority health threats (p. 32). ²¹⁶

Despite these comprehensive efforts, the system faces challenges. The IDSR strategy is yet to be fully adapted to the national context (p. 26), ²¹⁷ and a shift from a web-based surveillance system to Google Forms presents a need to "progress to a more robust system such as DHIS2" (p. 38). Timeliness of reporting for notifiable conditions was 53% in 2023 (p. 38). ²¹⁸ Furthermore, animal health surveillance is noted as not being on par with human health surveillance (p. 26). ²¹⁹ The National Health Strategic Plan 2022-2026 includes objectives to "Strengthen disease surveillance and response" and "Improve analytical capacity to maximize the use of surveillance data" (p. 58). ²²⁰

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

Seychelles possesses a functional NFP accessible for urgent communications with WHO, but faces limitations in its internal communication instruments across all levels and sectors of government. This is balanced by well-established and implemented multi-sectoral coordination mechanisms at both national and intermediate levels, which would ensure a comprehensive internal understanding of public health events for reporting purposes.

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, published in March 2018, provides the foundational context for this system. It explicitly states that the "national IHR focal point (IHR NFP) for Seychelles is situated within the Public Health Authority" and that this NFP is tasked with communicating with the WHO regional IHR contact points (p. 7). Furthermore, the JEE notes that Seychelles' "Public Health Act was revised in 2015 to comply with IHR implementation, and includes a provision for reporting a potential public health emergency of international concern (PHEIC) to WHO and OIE" (p. 29). The report confirms that the "Seychelles NFP has been consistently compiling and sending annual reports to the World Health Assembly (WHA) for the past eight years," illustrating a sustained and ongoing commitment to reporting (p. 29). It also highlights that the country has "demonstrated effective use of the IHR decision-making instrument to assess such events and notify to WHO and OIE," citing the 2017 plague outbreak as an instance where suspected cases were reported to WHO (p. 29, 30). The NFP's design is to be "accessible at all times to communicate with the WHO regional IHR contact points and with all relevant sectors and stakeholders in the country," underscoring an intent for timely communication (p. 7). ²²¹

The WHO IHR State Party Annual Report (SPAR) for Seychelles, 2024, provides quantitative scores that offer a precise understanding of the current status of these capacities. For C.2.1 NFP functions under IHR, Seychelles scores 40%. This score indicates that the "National IHR Focal Point is a designated centre and has a duty officer system to ensure accessibility at all times for urgent communications with WHO but legal, normative and institutional instruments and arrangements, including terms of reference describing the roles and responsibilities, are insufficient to communicate effectively with all levels and relevant sectors of the State Party’s administration." This definition from the WHO SPAR guidance document confirms that while direct urgent communication with WHO is enabled by a 24/7 accessible NFP, the internal mechanisms for the NFP to communicate broadly and effectively within the State Party's own administration are noted as insufficient. This aligns with the JEE 2018's identification of areas for strengthening, such as formalizing SOPs and internal communication (p. 30). ²²²²²³

Additionally, for C.2.2 Multi-sectoral IHR coordination mechanisms, Seychelles scores 80%. This score signifies that "Multisectoral coordination mechanisms for IHR implementation are in place, disseminated and are being implemented at national and intermediate levels." This demonstrates a strong and operational framework for internal collaboration among various sectors (health, animal, food, environment, etc.), which is crucial for gathering comprehensive information on public health events. The JEE 2018 corroborates this by mentioning an "IHR coordination mechanism exists within the IDSR Committee and has been in place since 2003" and functions as a "platform for intersectoral collaboration" (p. 7). ²²⁴²²⁵

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

The government of Seychelles operates an electronic reporting surveillance system that aims to function at both national and sub-national levels, though its full implementation and effectiveness at all sub-national points face ongoing challenges.

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, published in March 2018, explicitly states that "The Seychelles disease surveillance system employs the IDSR strategy of the WHO Regional Office for Africa… This system has different components: paper-based surveillance, web-based e-surveillance, sentinel surveillance and event-based (rumour) surveillance" (p. 26). It further clarifies that "The web-based reporting system created as a pilot for the Indian Ocean Games in 2011 has since been expanded to cover 57 reporting sites country-wide, including government and private facilities" (p. 26). This indicates that the system is intended for and deployed at a broad range of facilities, suggesting both national oversight and sub-national data entry points. The JEE also notes that "All facilities are connected to an intranet system" and that "GIS-based disease-mapping capabilities are in place" (p. 27), further supporting the existence of an electronic platform across various locations. ²²⁶

The National Health Strategic Plan (NHSP) 2022-2026 outlines the strategic direction "SD6 Improve Data for Impact," with the specific objective to "Set-up one integrated HIS" and to "Implement one integrated HIS for MoH" (p. 39, 87). This indicates a strategic commitment to consolidate and advance electronic health information systems. ²²⁷

However, the Annual Health Sector Performance Report (APR) for 2023 provides an updated and more nuanced picture of the electronic reporting surveillance system's current status and challenges. It states that "Reporting remains a challenge for disease surveillance with the discontinuation of the web-based surveillance system and the total reliance on Google Forms for reporting and Google Sheets for data management and analysis" (p. 38). This suggests a regression or a temporary workaround in the primary electronic surveillance system mentioned in the JEE. The report further emphasizes that "There is an urgent need to progress to a more robust system such as DHIS2, supported by training on Integrated Disease Surveillance and Response (IDSR)" (p. 38). This indicates that while electronic tools are in use (Google Forms/Sheets), a more integrated and robust electronic surveillance platform is still a pressing need and in development with the planned implementation of DHIS2. ²²⁸

The APR 2023 also details the progress of the eHIS (electronic Health Information System), noting that its "roll-out is progressing (estimated 88% of registrations in community health services in 2023 were captured, up from 29% in 2022)" (p. 4). This eHIS is being expanded for use in outpatient medical services, and "140 doctors were provided training on use of the EMRs in 2023" (p. 16). This indicates a significant electronic system for patient registration and medical records is operating and expanding at sub-national (community health services) and national (hospital) levels, even if the dedicated surveillance component currently relies on more basic electronic tools. The report also highlights that "The Department of Information Communication and Technology (ICT) has a team deployed to the MOH… introduced a new digital system for results dispatch from clinical lab" (p. 16), showing further electronic integration across different health service functions that contribute to overall national and sub-national data. ²²⁹

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

Score: 0

There is insufficient evidence that Seychelles' electronic reporting surveillance system collects ongoing or real-time laboratory data, however, the data collected can be disaggregated and analyzed by demographic factors such as age and sex. The potential for disaggregation by ethnicity is not explicitly detailed in every context.

Seychelles has an established, albeit evolving, system for managing laboratory data electronically. According to the Joint External Evaluation of 2018, the Seychelles Public Health Laboratory (SPHL) and the Clinical Laboratory (CL) utilized a laboratory information system that supported the electronic notification of results to clinicians (p. 23). ²³⁰ The Annual Health Sector Performance Report 2023 notes that the Ministry of Health (MOH) introduced a "new digital system for results dispatch from clinical lab" and provided training to laboratory staff on its use. This system was implemented by the Department of Information Communication and Technology (ICT) to improve network infrastructure (p. 16). ²³¹ The National Health Strategic Plan (NHSP) 2022-2026 includes the phased rollout of a comprehensive Electronic Health Information System (eHIS), with "Laboratory" modules specifically listed in "Phase II" of the implementation plan (p. 89). ²³²

The recent launch of the National Genomic Surveillance initiative by Seychelles aims to "establish a robust system for tracking pathogens, understanding disease trends, and identifying emerging threats through advanced genomic sequencing technologies." This initiative explicitly focuses on "integrated Genomic Surveillance" where "data generated through genomic sequencing will be integrated into the country’s existing surveillance systems," emphasizing the ability to "collect, analyze, and interpret genomic data in real-time". ²³³

Despite these advancements, full implementation of real-time, comprehensive laboratory data collection within a fully integrated eHIS is still a work in progress. The Annual Health Sector Performance Report 2023 notes that while the eHIS has seen increased use for patient registration, its application for "actual patient consultation, non-medical outpatient services and inpatient services remained below expectations" (p. 16). ²³⁴ The NHSP 2022-2026 also acknowledges that "partial implementation with a persisting parallel paper-based information system will increase workload on staff" and hamper the realization of "real-time data" (p. 101). ²³⁵

The surveillance and statistical reporting systems in Seychelles demonstrate a strong capacity for disaggregating and analyzing data by various demographic factors. The Annual Health Sector Performance Report 2023 presents numerous instances of health data disaggregated by age and sex. Examples include: Registered births by sex (p. 23); Age- and sex-distribution of deaths (p. 24); Life Expectancy at birth by sex (p. 25); Abortions by age-group (p. 25); Top causes of death by age-group (p. 27); CVD and Cancer Deaths by age-groups and sex (p. 29); HIV incidence and mortality rates by sex (p. 34); Haemodialysis patient cohorts by age and sex (p. 47). ²³⁶

The Public Health Act, 2015, which underpins surveillance activities, mandates the collection of detailed individual information for reporting of notifiable diseases. This includes "name, date of birth, sex, occupation, home and work addresses of the person affected" (p. 38). Such granular data, particularly date of birth, allows for precise age-based disaggregation. ²³⁷

The NHSP 2022-2026 explicitly lists "Identifying inequities" as a goal for improving data for impact (p. 85). Addressing inequities inherently requires the ability to disaggregate health data by various socio-demographic factors, which would logically include ethnicity. While direct mentions of ethnicity-based disaggregation are less frequent in the national documents, the collection of detailed personal identifiers like "home and work addresses" allows for geographical disaggregation, which can serve as a proxy for certain population groups or facilitate more targeted analysis if ethnicity data were also routinely collected and linked. ²³⁸ The JEE mentions "GIS-based disease-mapping capabilities" (p. 27), which, when combined with demographic data, can provide valuable insights into disease patterns across different communities or areas. ²³⁹

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the Seychelles. 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.²⁴⁰

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records (referred to as eHIS or EMRs) are increasingly in use in Seychelles, particularly for patient registration, and their implementation is actively being expanded, although they are not yet fully integrated for all aspects of patient care.

The National Health Strategic Plan (NHSP) 2022-2026 highlights the transition to an electronic health information system (eHIS) as a key strategic objective under "Improve Data for Impact." It notes that "Data capture is primarily paper-based" and that transitioning to eHIS "has been on MoH's agenda for over a decade," with work having "started to implement an eHIS system" in 2020 but subsequently stalled. The plan underscores an "urgent need to complete the implementation and move from a paper-based system to an electronic one" (p. 85). ²⁴¹

The Annual Health Sector Performance Report for 2023 provides the most recent evidence of progress and current status. It states that "the eHIS roll-out is progressing (estimated 88% of registrations in community health services in 2023 were captured, up from 29% in 2022)" (p. 4). This significant increase in registration capture demonstrates that for this specific function, electronic records are becoming commonly used at the sub-national level in community health services. ²⁴²

The report further indicates that "The Electronic Medical Records (EMR) system use was expanded in outpatient medical services, and 140 doctors were provided training on use of the EMRs in 2023" (p. 16). This expansion and training effort signify a deliberate move towards more common use of EMRs beyond just patient registration. However, the report also provides a nuanced view, stating that while eHIS showed a "continued increase in its use for registration of patients," its "use for actual patient consultation, non-medical outpatient services and inpatient services remained below expectations" (p. 17). This suggests that while commonly used for initial patient data capture, full integration into the workflow for comprehensive patient interactions and inpatient care is still a work in progress. ²⁴³

2.4.1b Public health system access to individual electronic health records

Score: 0

The national public health system in Seychelles has initiated and is progressing with the rollout of an electronic health information system (eHIS), which includes components for electronic health records. However, it is still limited.

In 2023, the eHIS roll-out captured an estimated 88% of registrations in community health services, a notable increase from 29% in 2022, as indicated in the Annual Health Sector Performance Report 2023 (p. 3). The Electronic Medical Records (EMR) system's use has been expanded in outpatient medical services, and 140 doctors received training on its application during 2023 (p. 16). ²⁴⁴ The National Health Strategic Plan 2022-2026 identifies the prompt implementation of eHIS as a key priority for improving health information systems (p. 33). ²⁴⁵

However, despite these advancements, the full implementation of eHIS has faced challenges. The transition to a fully electronic system has been on the Ministry of Health’s agenda for over a decade, with work commencing in 2020 but subsequently stalling. The Annual Health Sector Performance Report 2023 (p. 16) notes that while eHIS use for patient registration has increased, its application for actual patient consultations, non-medical outpatient services, and inpatient services remains below expectations. Furthermore, staff satisfaction with the system and data quality were yet to be evaluated as of 2023 (p. 16). ²⁴⁶ The persistence of a parallel paper-based information system is acknowledged as a risk that could increase workload and reduce the anticipated benefits of eHIS, as discussed in the NHSP 2022-2026 (p. 101). The plan for 2022-2026 includes a phased rollout of various eHIS modules, encompassing client registration, appointments, in-patient department, laboratory, radiology, billing, and doctors' desks, according to the NHSP 2022-2026 (p. 89). ²⁴⁷

A Digital Health Maturity Assessment in 2023 indicated that while many digital solutions are in use or being rolled out, the relevant policy frameworks and standards are not yet adequate, as mentioned in the Annual Health Sector Performance Report 2023 (p. 16). ²⁴⁸ The JJoint External Evaluation from 2018 also noted the presence of a web-based e-surveillance system covering 57 reporting sites and intranet connectivity across facilities, but pointed out weak internet connectivity in some areas and a lack of local interconnection between public health and veterinary surveillance systems (p. 27). ²⁴⁹

2.4.1c Existence of data standards for health record data comparability

Score: 0

Formal, overarching data standards to ensure comparability across the national public health system in Seychelles are not yet adequately in place. While efforts are underway to strengthen health information systems, the relevant policy frameworks and standards for data comparability and interoperability are noted as insufficient in the Annual Health-sector Performance Report 2023 (p. 16). ²⁵⁰

The National Health Strategic Plan 2022-2026 explicitly states that there are no formal standards and standard operating procedures (SOPs) currently in place to guide data management across its entire lifecycle, which would safeguard the quality and privacy of health data (p. 85). As part of the strategic objectives for improving data for impact, the plan aims to develop a data governance framework, including standards and SOPs for managing data throughout its lifecycle (p. 87). The goal to set up one integrated Health Information System (HIS) is intended to address the current fragmentation of data collection, processing, and use, and to reduce the reporting burden (p. 87). ²⁵¹

According to the Joint Externaç Evaluation (JEE), regarding specific quality measures, the Seychelles Public Health Laboratory (SPHL) is certified on the ISO9001:2008 quality management system (QMS) and is in the process of achieving accreditation through the WHO-endorsed Strengthening Laboratory Management Toward Accreditation (SLMTA) approach (p. 25). Additionally, the laboratory has the capacity to test susceptibility to antimicrobial agents using CLSI AST (Clinical Laboratory Standards Institute Antimicrobial Sensitivity Test) (p. 10). ²⁵² However, these are specific laboratory quality standards for processes and results, rather than broader data comparability standards across the entire health system. A Digital Health Maturity Assessment in 2023 also highlighted that Seychelles is "below average" in "standards and interoperability" compared to global averages, underscoring the need for adequate policy frameworks and standards in this area (p. 16). ²⁵³ The JEE recommended developing an interoperable, interconnected, electronic real-time reporting system that includes both public health and veterinary surveillance systems, capable of sharing data with all relevant stakeholders, which further suggests that comprehensive, comparable data standards across different sectors are a work in progress rather than a fully implemented reality (p. 27). ²⁵⁴

The 2023 Annual Hospital Services Statistical Report primarily presents quantitative data and comparisons across different years (2021, 2022, and 2023) for various hospital units and services, such as Accident & Emergency, Clinical Laboratory, Oncology, and Maternity. The report does not explicitly mention the existence or application of specific data standards, like ISO standards, to ensure the comparability of this data. While the report itself facilitates year-on-year comparisons of metrics like the number of tests conducted, admissions, and surgical procedures (e.g., Table 1, p. 10; Table 4, p. 11; Table 19, p. 21), it does not detail the underlying data governance frameworks or standardization protocols that enable such comparability across different departments or over time. The document's purpose is to summarize activities through statistics, rather than to describe the data management standards in place (p. 7). ²⁵⁵

2.4.2a Data sharing mechanisms

Score: 0

There is evidence of existing interaction and efforts to establish formalized mechanisms for data sharing between ministries responsible for animal, human, and wildlife surveillance in Seychelles, but these mechanisms are not yet fully established or seamlessly integrated.

The Joint External Evaluation (JEE) report from 2018 highlights that while a coordination mechanism exists within the Integrated Disease Surveillance and Response (IDSR) Committee, which includes both animal health (Veterinary Department) and human health (Epidemiology Unit of the Public Health Authority) sectors, this communication requires formalized processes, protocols, and standard operating procedures (SOPs) for sustainability (p. 7-8). The JEE report explicitly states that "there is no formalized and streamlined multi-sectoral collaboration for surveillance and response to zoonotic events" (p. 13). It further notes that "public health and veterinary surveillance systems are not yet locally interconnected" (p. 28). ²⁵⁶

The National Health Strategic Plan (NHSP) 2022-2026 acknowledges that the One Health approach, which promotes multi-stakeholder collaboration for better public health outcomes, "is yet to be well understood and appreciated by the different sectors" and that there is "an urgent need to build strong partnerships with non-health sectors to prevent effectively detect, prevent and respond to zoonosis and food safety problems" (p. 55). As a strategic objective, the NHSP aims to "Establish coordination mechanism for One Health approach" with a milestone to have "Formalized processes in place to guide communication between animal health and human health sectors" (p. 58). ²⁵⁷

The Annual Health Sector Performance Report 2023 mentions that the Réseau SEGA surveillance platform, a regional initiative, is expanding to include climate-sensitive diseases and health risks, which implies some level of national participation and data sharing across sectors for these specific risks (p. 36). It also notes that a national vector control plan is under development to prevent vector-borne diseases, which would inherently require inter-sectoral collaboration (p. 37). However, the overarching challenge remains the need for formalized and robust mechanisms for data sharing across animal, human, and environmental health sectors for comprehensive surveillance. ²⁵⁸

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

Score: 100

Seychelles indeed makes de-identified health surveillance data on infectious diseases publicly available through various reports published on government websites, specifically those of the Ministry of Health (MOH). This practice is explicitly stated and demonstrated across several official publications.

The Annual Health Sector Performance Report 2023 clearly outlines the MOH's commitment to information dissemination. "The MOH regularly disseminates various information products based on routine administrative data collected from various sources within the Ministry. These products provide stakeholders with up-to-date information on the health sector's performance, achievements, and challenges. Recent versions of all key reports are available on the MOH official website." (p. 15) This report itself serves as a prime example, presenting aggregated surveillance data on infectious diseases. For instance, Table 16, "Notifiable conditions reported in 2023 to DSRU" (p. 38), lists case counts for a wide range of infectious diseases such as COVID-19 (3,263 cases), Dengue Fever (280 suspected cases), HIV/AIDS (85 new cases), Hepatitis B (20 new cases), Syphilis (148 cases), and Tuberculosis (23 cases), among others. These figures are presented in an aggregated, de-identified format, protecting individual privacy while informing the public of disease burdens. The report also includes figures and tables on HIV incidence and mortality rates (Figure 22, p. 34), new cases of viral hepatitis (Figure 23, p. 34), and STIs (Figure 25, p. 35). ²⁵⁹

The 2023 Annual Hospital Services Statistical Report provides aggregated data related to hospital services, which includes insights into infectious disease encounters, again, in a de-identified format. Section 10, "Communicable Diseases Control Unit (CDCU)" (p. 27), presents total new and repeat attendances at CDCU clinics, disaggregated by island, age group, and sex. This data, while not directly "surveillance" in the real-time sense, reflects aggregated patient interactions for infectious diseases managed by the unit. For example, Table 26 shows "New and Repeat Attendances by Islands at CDCU, 2023", detailing total attendances without individual identifiers. The summary of hospital statistics also includes aggregated figures for various services, like total diagnostic tests conducted (including microbiology), which contribute to the overall picture of infectious disease burden within the hospital setting (p. 8). ²⁶⁰

The Primary Health Care Annual Statistical Report 2023 details aggregated statistics from primary healthcare services, some of which are directly relevant to infectious disease surveillance. Section 1.7, "Expanded Immunisation Programme" (p. 9), presents Table 11, "Vaccination Coverage, 2023", showing de-identified data on coverage rates for various vaccines (e.g., BCG, Pentavalent, MMR) across different age groups. This is crucial de-identified data used for monitoring public health's defense against infectious diseases. Section 1.5, "Maternal and Child Health" (p. 7), includes aggregated data on visits for MCH services (Tables 8 and 9), which are essential for tracking the health of mothers and children, including data that could indicate prevalence of certain infections or conditions relevant to this vulnerable group (e.g., related to immunisation uptake or follow-up post-delivery). ²⁶¹

These reports, all published by the Ministry of Health, consistently provide aggregated, de-identified health surveillance data and related statistics on infectious diseases.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Seychelles has established a foundational legal framework for protecting the confidentiality of identifiable health information through the Data Protection Act, 2023.

The 2023 Data Protection Act directly addresses the safeguarding of confidential and identifiable health information. The Act defines "sensitive personal data" as "personal data related to the most private areas of the data subject’s life, or whose misuse might lead to discrimination or involve a serious risk for the data subject". Crucially, Section 22 of the Act explicitly lists "health" as a category of sensitive data. It mentions that "Processing of personal data relating to race, ethnic origin, biometrics, genetics, political opinions, religious or philosophical beliefs or for the purpose of identifying a person's health or sex life is prohibited." This prohibition comes with specific exceptions, primarily requiring explicit consent from the data subject or being necessary for public interest, medical diagnosis, or provision of health care, all under appropriate safeguards. The Act also establishes obligations for data controllers and processors regarding safe custody, transparency, data security and confidentiality (Part VI), and grants data subjects rights such as the right to access, rectify, or delete their data (Part V). This legislation thus provides a robust legal basis for protecting the confidentiality of identifiable health information, including that generated through health surveillance activities. ²⁶²

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

Score: 100

Explicit legislation and/or regulations specifically safeguarding the confidentiality of identifiable health information, such as that generated through health surveillance activities, and including protections against cyber attacks like ransomware, are addressed by the newly enacted Data Protection Act, 2023.

The Data Protection Act, 2023 (Act 24 of 2023) provides a legal framework for protecting personal data, including health information, from various threats, including cyberattacks. Health information falls under the definition of "sensitive personal data" in Section 2 of the Act, which refers to "personal data related to the most private areas of the data subject’s life, or whose misuse might lead to discrimination or involve a serious risk for the data subject". Section 22(1) explicitly prohibits the processing of personal data related to "identifying a person's health or sex life" unless specific conditions are met, ensuring a high level of protection for health data.

Furthermore, the Act directly addresses the need for protection against digital threats. Section 42, titled "Security of processing," mandates that data controllers and data processors implement appropriate technical and organizational measures to ensure a level of security appropriate to the risks, including the ability to restore data, and crucially, to prevent data corruption. Specifically, Section 42(4)(c) states: "The data controller and data processor shall implement measures designed to — (…) prevent data corruption in case a system used in connection with the processing malfunctions or suffers a cyber vulnerability." This provision directly speaks to protections against cyber threats, such as those that could lead to ransomware attacks or data corruption. The Act also requires data controllers to notify the Commission within 72 hours of a personal data breach and, in significant cases, communicate the breach to the data subject. ²⁶³

2.4.5a Cooperative commitments or agreements within regions

Score: 100

Seychelles has the legal framework and regional commitment for data sharing during public-health emergencies, but the evidence for actual, disease-specific surveillance data sharing with other countries (beyond general IHR reporting) is not found in the publicly accessible documentation.

This commitment is fundamentally rooted in its national legal framework. According to the Joint External Evaluation, the Public Health Act 2015 provides the underlying legal structure for public health management and has been explicitly "revised and adjusted to fulfil the requirements of IHR compliance" (p.5). Crucially, this Act "includes a provision for reporting a potential public health emergency of international concern (PHEIC) to WHO and OIE" (p.29). This legislative provision, confirmed by the JEE, ensures that the country's legal obligations under the International Health Regulations (IHR) are supported, thereby mandating the sharing of surveillance data with international bodies like the World Health Organization (WHO) and the World Organisation for Animal Health (OIE) during emergencies. ²⁶⁴ However, it is important to note that this framework does not specify provisions to share with other countries.

In terms of cooperative agreements, the JEE highlights a significant regional commitment: "the country has produced a memorandum of understanding (MOU) with all Indian Ocean countries to provide a collaboration and coordination framework to guide preparation for, and response to, public health emergencies with the potential for international spread through seaports and airports" (p.5). This MOU directly facilitates cross-border collaboration and coordination in managing health emergencies. The JEE report further notes Seychelles' consistent engagement with international reporting mechanisms, stating that the National IHR Focal Point (NFP) has "consistently compiling and sending annual reports to the World Health Assembly (WHA) for the past eight years" and has "demonstrated effective use of the IHR decision-making instrument to assess such events and notify to WHO and OIE" (p.29-30). This regular reporting to international bodies signifies an ongoing commitment to data sharing. ²⁶⁵

Additionally, the United Nations Sustainable Development Cooperation Framework (UNSDCF) for Seychelles 2024-2028 emphasizes the country's broader commitment to partnerships, stating that "South-South cooperation, regional partnerships and partnerships with other vulnerable SIDS offer opportunities to leverage national capacities and develop mutually beneficial partnerships for progress towards the SDGs" (p.17). ²⁶⁶ This framework underscores a general policy of international cooperation that would naturally extend to health surveillance during emergencies. The Country Cooperation Strategy (CCS) 2024-2030 also reiterates Seychelles' active participation in "global and regional intergovernmental forums to showcase its leadership, foster alliances, and advocate for SIDS on health issues" (p.17), further cementing its stance on international collaboration in health matters. ²⁶⁷

Seychelles is a member state of the Africa CDC Eastern Africa RCC network, which among its priority diseases lists viral haemorrhagic fevers (including Rift Valley fever) and is tasked with strengthening surveillance and laboratory systems in the region. ²⁶⁸ Seychelles is also a member country of the SEGA One Health Network, a regional group tasked with enabling the sharing of epidemiological information provided by member states’ surveillance departments. This regional framework further reinforces Seychelles' practical commitment to data sharing among neighboring nations. ²⁶⁹

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

Score: 0

There is no explicit mention of a national system specifically designed to provide support at the sub-national level for contact tracing (e.g., through dedicated training, metrics standardization, or specific financial resources) during a public health emergency.

National documents do outline broader efforts related to public health emergencies and surveillance that would implicitly support elements of contact tracing, but they do not detail a dedicated national system for sub-national contact tracing support.

For instance, the National Health Strategic Plan 2022-2026 aims to "Improve Health Security" (p. II) and emphasizes implementing Integrated Disease Surveillance and Response (IDSR). Key interventions include strengthening disease surveillance and response and rolling out IDSR training to human and animal health staff (p. 58). ²⁷⁰ The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles (2018) also notes that the country's disease surveillance system employs the IDSR strategy and that "Focal points are in place in all reporting sites" (p. 26, 27). It mentions "Periodic training is required on IDSR, to be held at least annually" (p. 27). While IDSR frameworks typically involve case investigation and follow-up activities that are integral to contact tracing, the documents do not specify the national system of support for contact tracing in terms of standardized metrics, dedicated financial allocations, or specific contact tracing training at the sub-national level. ²⁷¹

The Annual Health Sector Performance Report 2023 mentions that "Disease investigations for reported cases of certain notifiable conditions were undertaken" (p. 37), which would involve elements of contact tracing. It also highlights challenges with data management for surveillance, stating that "Reporting remains a challenge for disease surveillance with the discontinuation of the web-based surveillance system and the total reliance on Google Forms for reporting and Google Sheets for data management and analysis. There is an urgent need to progress to a more robust system such as DHIS2, supported by training on Integrated Disease Surveillance and Response (IDSR)" (p. 38). This indicates ongoing efforts to improve surveillance, but does not specify a national support system for contact tracing at the sub-national level. ²⁷²

The WHO Country Cooperation Strategy 2024–2030 also mentions "Capacity building for health workforce: support capacity-building initiatives for the health workforce to enhance their ability to respond to health emergencies and deliver essential services" (p. 16). This refers to general workforce capacity but does not delve into the specific details of supporting sub-national contact tracing. ²⁷³

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

Score: 0

There is no explicit mention of a national system that provides specific economic support (such as paychecks or job security) or dedicated wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended. However, the general provision of medical attention is implicit within the country's healthcare system.

National documents extensively discuss the importance of public health measures, including isolation and quarantine, particularly in the context of public health emergencies like the COVID-19 pandemic. For instance, the Infection Prevention and Control 5-Year Strategic Framework 2021-2025 mentions "Written policy/guidelines for placing patients with potentially contagious or communicable infections with clearly defined responsibilities are captured in the IPC guidelines/SOPs" (p. 10). ²⁷⁴ Similarly, the Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles (2018) notes "processes (national IPC guidelines) and legislation (the Public Health Act) in place for isolation and quarantine in the event of a suspected outbreak of infectious disease" (p. 9). ²⁷⁵

The country's healthcare system generally aims to provide medical attention. The country report from RAD-AID International states that "The Government of Seychelles provides free health services to the entire population" (p. 17). ²⁷⁶ The National Health Strategic Plan (NHSP) 2022-2026 highlights the goal to "Protect and Improve Universal Health Coverage" and "Improve Health Security," with interventions such as ensuring "continuity of essential health services during health emergencies" and implementing "Clear guidelines for care of long-COVID/post-COVID syndrome" (p. II, 54). This suggests that medical care for those affected by illness, including during isolation, would be provided. ²⁷⁷

While the NHSP 2022-2026 acknowledges that the "COVID-19 crisis has negatively affected all the building blocks of the health system, as well as jobs, livelihood, and the economy as a whole" (p. 3), and the Annual Healt Sector Performance Report 2023 notes "lost productivity and isolation from each episode of illness" due to COVID-19 (p. 33), these documents do not specify any government-led programs for economic support (e.g., paychecks, job security) or other social wraparound services specifically to facilitate compliance with self-isolation or quarantine recommendations for the general public or their contacts. The focus of the documents is primarily on public health measures, health system capacity, and general healthcare provision, rather than dedicated socio-economic support systems linked directly to isolation mandates. ²⁷⁸²⁷⁹

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

Seychelles demonstrates intersectoral coordination and aligned contingency planning at POE. However, based on available evidence, no formal cooperative agreement was identified that explicitly includes contact tracing responsibilities between border control authorities and the public health system.

The Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles, conducted in March 2018, provides substantial detail on these arrangements. It highlights that the "public health emergency contingency plan for responding to emergencies at Seychelles International Airport is integrated with the National Public Health Emergency Response plan," and that this plan "covers all relevant agencies at the airport" (p. 47). Furthermore, the JEE explicitly states that "Screening for International Certificates of Vaccination or Prophylaxis is carried out in collaboration with immigration authorities," indicating a specific cooperative activity for identifying potential health risks among international travelers (p. 48). ²⁸⁰

The linkages extend beyond immigration to broader security agencies, as "The Public Health Authority and the security agencies benefit from close linkages. These are enshrined in the Public Health Act 2014, the Public Health Authority Act, the Police Act and the Defence Force Act" (p. 40). More broadly, "The Public Health Authority, law enforcement, port/airport control and customs are linked during unusual health events or suspected outbreaks" (p. 7), and "Points of contact have been identified in the respective agencies, and clear procedures for health notifications have been disseminated" (p. 40). ²⁸¹

For managing identified cases and their contacts, the JEE notes that "Should quarantine become necessary, the accommodation facility designed to house illegal immigrants for deportation has been designated for that use" (p. 47), indicating a pre-identified facility for quarantine. Health personnel are also "in place for the inspection of conveyances at designated POE," and there is "direct communication between designated points of entry and the PHA, the Emergency Service Centre, and the nearest health facilities" (p. 47-48). The JEE also discusses multi-sectoral coordination through the Integrated Disease Surveillance and Response (IDSR) Committee (p. 7), which would be instrumental in overall emergency response, including tracing of contacts. ²⁸²

However, the JEE does not provide evidence of a formal written agreement (e.g., MOU, SOP, joint policy) between border authorities and the public health system that specifically defines shared responsibilities for case management and contact tracing of international travelers. While the JEE describes communication channels and collaborative mechanisms, it does not reference a specific agreement outlining roles for contact tracing at POE. ²⁸³

Evidence from the Annual Health Sector Performance Report for 2023 (APR 2023) further supports the existence of cooperation between the public health system and border control authorities in Seychelles. The APR 2023 highlights that Public Health Services personnel actively "inspected all sea vessels and aeroplanes for public health risks, including sick passengers/crew and invasive species" (p. 37). This aligns with the broader mandate of Public Health Officers who "play a crucial role in upholding relevant standards, laws and regulations and ensure their enforcement across a range of areas, to reduce health risks" (p. 37), suggesting a sustained, proactive approach to health security at borders. However, it does not describe an integrated operational plan for contact tracing between agencies. ²⁸⁴

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

Score: 100

Seychelles provides resources for its citizens to participate in applied epidemiology training programs and has recently commenced an in-country program.

Previously, as of the Joint External Evaluation (JEE) in March 2018, there was no Field Epidemiology Training Programme (FETP) or similar applied epidemiology training established within Seychelles. However, the government did provide resources for citizens to pursue such training abroad. The JEE noted that staff were participating in overseas programs through existing agreements, resulting in one fully trained epidemiologist and others undergoing training through the Indian Ocean Community (IOC) FETP (p. 33). ²⁸⁵ The National Health Strategic Plan (NHSP) 2022-2026, while reflecting a need to "Strengthen Human Resources for Health," identified a priority action to "Establish a basic Field Epidemiology Training Programme at the National Institute for Health and Social Services for frontline human, animal and environmental public health staff" (p. 32), indicating that an in-country program was a recognized future goal. ²⁸⁶

More recent information indicates significant developments. A January 24, 2024, announcement confirmed that "The first cohort of the Field Epidemiology Training Program-Frontline (FETP-Frontline) in Seychelles successfully commenced" in the country. This program offers skills in disease detection, surveillance and management, integrating human, animal and environmental health. ²⁸⁷ On April 19, 2024, Seychelles celebrated the certification of its first graduate from the Field Epidemiology Training Program (FETP), whose training was focused on building capacity in identify epidemics, investigate their causes, and implement effective control measures. ²⁸⁸

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

The available Field Epidemiology Training Programs are explicitly inclusive of animal health professionals.

The "FETP-Frontline: launch of the first cohort in Seychelles" article explicitly states that the program aims for participants to "acquire essential skills in disease detection, surveillance and management, integrating human, animal and environmental health". ²⁸⁹

Furthermore, the Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Seychelles (2018) already indicated the intention and some progress in this area. It noted that "Animal health personnel are enrolled in ongoing regional FETP" (p. 15) and that there were "plans to extend the FETP provided under IOC to include animal health" (p. 33). ²⁹⁰ This earlier documentation underscores a long-standing commitment to including animal health. The article reinforces this by stating that "This training course is aligned with the One Health approach," which inherently encompasses animal health perspectives. ²⁹¹

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

Score: 100

There is public evidence that Seychelles has more than 1 trained field epidemiologist per 200,000 people.

On 19 April 2024, 18 Seychellois public health professionals successfully completed the Field Epidemiology Training Program (FETP) Frontline module, making them certified Field Epidemiologists. Given the current population of Seychelles is 121,355 (2024), having 18 trained field epidemiologists significantly surpasses the requirement of at least 1 per 200,000 people. ²⁹²²⁹³

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 0

Seychelles does not currently have an overarching national public health emergency response plan specifically designed to address multiple communicable diseases with epidemic or pandemic potential. While the National Health Strategic Plan (NHSP) 2022-2026 provides a broad framework and strategic intent for strengthening health security, such as preparing, preventing, detecting, and responding to health emergencies, it is primarily a sectoral planning document rather than a dedicated emergency response plan.

The National Health Strategic Plan (NHSP) 2022-2026 sets a clear goal to "Prepare, prevent, detect early and respond to all health emergencies" (p. 36). Strategic Direction 3 (SD3) of the NHSP is dedicated to "Improve Health Security," which specifically involves identifying outbreaks, enhancing crisis response capabilities, and safeguarding the health of the population (p. III). ²⁹⁴

Under SD1, the NHSP outlines key interventions to "Build strong governance and leadership structure," including the development of a "governance structure for health emergencies with clear roles and responsibilities" (p. 43). Furthermore, under SD2, there are specific objectives to "Finalise and implement the Continuity of Essential Health Services (CEHS) plan" and an "Emergency Operations Plan and SOPs" (p. 54). The document also mentions that a "National Action Plan for Health Security (NAPHS)" is intended to be validated and operationalized to strengthen multi-sectoral collaboration in health security (p. 58). The country has already validated the Integrated Disease Surveillance and Response (IDSR) Technical Guidelines, although their rollout was delayed (p. 55). The NHSP acknowledges a range of communicable diseases of importance, such as HIV/AIDS, Viral Hepatitis C, Dengue, Leptospirosis, and COVID-19, confirming that planning addresses multiple diseases (p. 56). ²⁹⁵

The National Health Strategic Plan 2022-2026, which outlines these strategic directions and intentions, is itself a public document. However, while it details the strategic intent and frameworks for emergency response, the public availability of the specific operational plans (such as the detailed "Emergency Operations Plan and SOPs" or the fully operational "NAPHS") is not explicitly confirmed within this document. ²⁹⁶

The NHSP addresses funding at a strategic level, acknowledging existing challenges. It states that "The health budget is unlikely to increase substantially in the next few years" and notes that the COVID-19 pandemic "diverted additional funds away from interventions proposed in this strategic plan" (p. 101). As part of SD5 ("Invest for Results"), the Ministry of Health (MoH) will "explore alternative financing sources such as national insurance funds, social enterprising, accessing global, regional and bilateral supports, and public-private partnerships" to ensure health sustainability (p. 76). Additionally, "Mobilize funds for health from partners" is listed as a mitigation strategy for the risk of budget allocation not commensurate with health needs (p. 102). This indicates an awareness of funding needs and a strategic approach to secure resources, rather than a confirmation of current full funding for all specific emergency response operational plans. ²⁹⁷

While the NHSP provides significant strategic and policy guidance for health security, it does not meet the criteria for an overarching, operational public health emergency response plan. As such, there is currently no confirmed evidence of a dedicated national plan that comprehensively addresses preparation for multiple communicable diseases with epidemic or pandemic potential. The WHO Strategic Preparedness and Response Portal (SPH) notes that for a "NAPHS," the status for Seychelles is "No Data!". ²⁹⁸

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

Score: 0

Seychelles does not currently have an overarching national public health emergency response plan specifically designed to address multiple communicable diseases with epidemic or pandemic potential. Therefore, there is no evidence of such a plan being updated within the last three years.

While the National Health Strategic Plan (NHSP) 2022-2026 was developed and published in June 2022, it is primarily a broad health sector policy and planning framework. The NHSP outlines strategic directions related to health security and emergency preparedness, but it does not function as an operational emergency response plan. As such, it cannot be considered an overarching public health emergency response plan for the purposes of this assessment. ²⁹⁹

The WHO Strategic Preparedness and Response Portal (SPH) notes that for a "NAPHS," the status for Seychelles is "No Data!". ³⁰⁰

3.1.1c One health principles by covering multiple threat types

Score: 0

Seychelles does not have an overarching national public health emergency response plan specifically addressing multiple threat types, including antimicrobial resistance (AMR), zoonotic disease spillover, biological accidents, or deliberate acts. While the National Health Strategic Plan (NHSP) 2022-2026 references One Health principles and outlines strategic directions to strengthen health security, it is a broad health sector policy and planning framework rather than an operational emergency response plan.

The NHSP 2022-2026 explicitly states under Strategic Direction 3 (SD3), "Improve Health Security," that the "One Health approach, which promotes multi-stakeholder collaboration to achieve better public health outcomes, is yet to be well understood and appreciated by the different sectors" (p. 55). It then elaborates on the importance of this approach: "One key aspect of One Health is the collaborative, multi-sectoral, and transdisciplinary approach working at the local, regional, national, and global levels, to achieve optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment" (p. 55). The plan highlights an "urgent need to build strong partnerships with non-health sectors to prevent effectively detect, prevent and respond to zoonosis and food safety problems" (p. 55). ³⁰¹

Specific objectives under SD3 further reinforce this. Specific objective 3.1 is to "Strengthen the One Health approach," with a key intervention to "Establish coordination mechanism for One Health approach" (p. 58). Milestones include a "National One Health Coordination Committee established" and "Formalized processes in place to guide communication between animal health and human health sectors" (p. 58). The document also notes that the "National Action Plan for Health Security (NAPHS) will guide the process to strengthen this multi-sectoral collaboration" (p. 55). ³⁰²

The National Health Security Plan (NHSP) 2022–2026 highlights specific types of threats within its health security framework. Antimicrobial resistance (AMR) is explicitly noted in the introduction to Strategic Direction 3, where the plan states that “the misuse of antimicrobials are disrupting the equilibrium of the microbial world,” emphasizing its role in driving emerging diseases (p. 55). Zoonotic disease spillover is also identified as a priority area, particularly in relation to fostering “strong partnerships with non-health sectors” through the One Health approach, which underscores the interconnectedness of human, animal, and environmental health in mitigating these risks (p. 55). ³⁰³

While the NHSP incorporates elements of One Health principles at a strategic level, it does not constitute an overarching national public health emergency response plan covering multiple threat types. There is no evidence of such a dedicated, comprehensive plan currently in place. The WHO Strategic Preparedness and Response Portal (SPH) notes that for a "NAPHS," the status for Seychelles is "No Data!". ³⁰⁴

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Seychelles does not have an overarching national public health emergency response plan in place. Therefore, there is no evidence to confirm whether such a plan includes consideration of the impact of health equity or mechanisms for identifying and addressing the needs of vulnerable populations. While the National Health Strategic Plan (NHSP) 2022-2026 emphasizes equity and outlines strategies to ensure no one is left behind, it is a broad health sector policy and planning framework.

The NHSP explicitly aims for "the attainment, by all people living in Seychelles, of the highest level of physical, social, mental and spiritual health and living in harmony with nature" as its national vision for health (p. 36). This vision inherently addresses equity by aiming for the highest level of health for all people. Furthermore, one of the strategic goals of the NHSP is to "Achieve and sustain all dimensions of UHC" (Universal Health Coverage) (p. II, 36). The definition of UHC, as cited in the document, is "that all people have access to the health services they need, when and where they need them, without financial hardship on them" and emphasizes "high quality health services… through people-centred primary care" (p. 47). ³⁰⁵

The document notes that while health services are "free, easy to access geographically and have high utilisation rates," the "quality, equity, outcomes and user experience and satisfaction are not adequately measured." It also states, "This may imply certain population groups may be ‘left behind’, but not picked up by current routine monitoring – making a case for stronger measurement of these aspects of care" (p. 47). Under "SD2 Priority Areas," it explicitly states the need to "Ensure no one is left behind: Measure and improve equity in access to health services, and health outcomes" (p. 49). ³⁰⁶

The NHSP highlights social determinants of health (SDHs) as critical factors influencing health and well-being. It defines SDHs as "the conditions in which people are born, grow, live, work and age" and lists factors like "socioeconomic stability, education, neighbourhood and physical environment, employment, and social support networks" (p. 60). The document draws connections between poor SDHs and risk factors leading to disease (p. 61).

The plan specifically addresses a range of vulnerable groups in society by recognizing the social and structural factors that influence health outcomes. For individuals of lower socioeconomic status, the document emphasizes that addressing social determinants of health is crucial not only for improving overall health but also for reducing disparities rooted in social and economic disadvantages. It highlights that higher income and social status are typically associated with better health, while greater inequality leads to wider health differences. The Multidimensional Poverty Index (MPI) report of 2019 is also cited, showing that conditions such as overcrowded households, substance abuse, unemployment, and low education levels contribute significantly to multidimensional poverty, which in turn has a negative impact on health status (p. 61). ³⁰⁷

Age is another important factor the plan considers, adopting a life-course approach as a priority area for addressing health needs. This includes improving health services at every stage of life, as outlined in SD2, which seeks to enhance care across the life-course (p. 50). Similarly, SD4, “Promote Healthy Populations,” stresses the importance of promoting healthy living for all age groups, while also acknowledging gaps in child and adolescent health promotion within the life-course framework (p. 64). Furthermore, the plan recognizes the growing demands that will accompany an aging population, particularly in relation to health and social care services (p. 12). ³⁰⁸

The plan also identifies substance abuse and mental health as areas of vulnerability requiring focused attention. It acknowledges that the combination of widespread substance abuse, harmful alcohol use, and poverty creates conditions conducive to social problems such as gender-based violence and child abuse (p. 15). To address this, SD2 includes specific objectives to combat discrimination, protect the rights of vulnerable groups, and improve access to health and social services, both in existing facilities and in those planned for the future (p. 50). It also calls for targeted interventions designed specifically for these populations. In addition, SD4 prioritizes the promotion of good mental health and the prevention and management of substance abuse, further reinforcing the plan’s commitment to supporting these vulnerable groups (p. 65).Furthermore, under SD1, a specific objective is to "Engage the community," with key interventions to "Develop mechanisms to engage vulnerable and key populations and their advocates in relevant policies and programmes" (p. 44). This directly implies mechanisms for identifying and addressing their needs. ³⁰⁹

While the NHSP highlights health equity and identifies mechanisms to support vulnerable populations, it does not serve as an overarching public health emergency response plan. As a result, there is no evidence of a dedicated emergency plan that explicitly integrates these elements. The WHO Strategic Preparedness and Response Portal (SPH) notes that for a "NAPHS," the status for Seychelles is "No Data!". ³¹⁰

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

Score: 100

Seychelles has identified the need for and outlines some mechanisms for engaging with the private sector, particularly for aspects relevant to outbreak emergency preparedness and response.

The National Health Strategic Plan (NHSP) 2022-2026 recognizes the rapid expansion of the private health sector and the need for improved engagement. It identifies "poor communication" and "weak private-sector regulatory frameworks" as outstanding issues (p. 31). ³¹¹

To address these, the NHSP proposes the following mechanisms for engagement. Under Strategic Direction 1 (SD1), "Strengthen Leadership, Governance and Administration," the plan includes the intervention to "Conduct annual coordination meetings with the private health sector and civil society" (p. 44). While these are general coordination meetings, they provide a structured platform for engagement that can include discussions on emergency preparedness. A more direct mechanism for emergency response is stated under the "Roles and Responsibilities of Non-State Health Service Delivery Actors (Private sector, PNFPs, NGOs, TCMP)." The private health sector is explicitly required to "Report notifiable diseases and other health statistics as required" (p. 96). This is crucial for early detection and response to outbreaks. Under Strategic Direction 2 (SD2), "Protect and Improve Universal Health Coverage," the plan aims to "Improve collaboration with private health sector and health-related NGOs." Key interventions involve exploring "social franchising" to "Utilise private health sector and/or health-related NGOs to help deliver key preventive, promotive and primary care services" (p. 53). While primarily focused on routine services, this establishes a framework for collaboration that could be adapted or expanded during emergencies. Strategic Direction 3 (SD3), "Improve Health Security," highlights the need to "Strengthen regulatory functions of the PHA" and address that "private-sector regulatory frameworks are weak, with inadequate reporting" (p. 31, 57). The Public Health Authority (PHA) is tasked with developing legislation, tools, and processes for regulating the private health sector (p. 57). ³¹²

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

Score: 100

The country has policies, plans, and guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic, with multiple documents outlining these measures.

The Seychelles National Integrated Emergency Management Plan (NIEMP) broadly covers "health and sanitary events like epidemics, pandemics" within its scope, stating that the plan's procedures offer a flexible and scalable approach to emergency management that can be implemented as needed (p. 2, 3). Under the "Concept of Operations," crisis management is described as involving "protective or other measures put in place to mitigate its effects, prevent further damage or disruption," and may include "providing public health advice, evacuating those at risk" (p. 26). Furthermore, within Functional Area II: Health, the NIEMP details tasks such as "control of epidemiological surveillance" and "environmental health (management of vectors and domestic animals, basic sanitation,)" which involve interventions that are non-pharmaceutical in nature (p. 44). Task 2.4, Environmental Health, specifically outlines "surveillance, control, and monitoring of water quality, food and beverages, solid waste, handling and disposal of human waste and wastewater, and vector control" as key actions (p. 45). ³¹³

The National Health Strategic Plan (NHSP) 2022-2026 explicitly addresses the COVID-19 pandemic and sets a goal to "Prepare, prevent, detect early and respond to all health emergencies" (p. II). Strategic Direction 3 (SD3), "Improve Health Security," aims to "Identify outbreaks and other health threats" and "Improve crisis response and protect the health of the population" (p. II). The document notes that Seychelles "moved quickly to implement required public health measures and health system response" during the initial phase of the COVID-19 pandemic (p. 56). SD3 also includes specific objectives such as "Implement the IHR to prevent, and swiftly detect and manage disease outbreaks" and "Implement IDSR" (Integrated Disease Surveillance and Response), which involve NPIs like surveillance, contact tracing, and isolation measures (p. 58). Moreover, the NHSP details interventions to "Institutionalise COVID-19 care and other related considerations throughout the health system," and to "Finalise and implement the Continuity of Essential Health Services (CEHS) plan," which would inherently rely on NPIs to ensure safety and continuity during a pandemic (p. 54). ³¹⁴

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 is particularly focused on NPIs. The preface directly highlights the importance of NPIs, stating, "The COVID-19 pandemic has taught us just how vital infection prevention and control is. Hand washing has taken on a new meaning; face masks have moved out of the clinical setting into our everyday lives" (p. 1). The framework outlines its scope to include "evidence–based practical solutions" for IPC, such as "Utilization of evidence-based and context specific practices for medical and other clinical procedures" and "Environment and infrastructural considerations for limiting the spread of infections" (p. 5). It confirms that "The country has an emergency preparedness and readiness plan that includes IPC interventions," covering aspects like "roles and functions of different agencies, training, surveillance, logistics, communication and surge capacity" (p. 10). The document explicitly mentions "Written policy/guidelines for placing patients with potentially contagious or communicable infections… Isolation wards/units or holding areas," and emphasizes that "Effective isolation of patient with infectious diseases is fundamental in reducing the risk of disease transmissions" (p. 10). Strategic Objective 10.2 aims to "Promote the utilization of multimodal strategies (MMS) for implementing infection prevention and control activities," which includes developing and disseminating "guidelines/SOPs on the use of multimodal strategies (MMS) to implement all the standards and transmission-based precautions" (p. 17). These precautions cover a wide range of NPIs, such as hand hygiene, respiratory hygiene/cough etiquette, and the use of personal protective equipment (p. 19). ³¹⁵

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

Score: 0

There is insufficient evidence to confirm whether Seychelles 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

While the Annual Health Sector Performance Report 2023 mentions several infectious disease issues, such as an "outbreak of respiratory illness… detected in November [2023], with a corresponding increase in deaths" and a "public health alert raised" for this event (p.5, 32), it does not specify that the national emergency response plan was formally activated. The report also notes the "ongoing dengue epidemic since 2015" but does not indicate activation of a national plan for it in the past year (p.32). The activation of a "health incident management command" mentioned in response to the 7th December 2023 explosion was for a disaster, not specifically an infectious disease outbreak (p.44). ³¹⁶

The Annual Health Sector Performance Report 2023 mentions a "3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs) from 2nd-14th May 2023" (p.32), but this was a training workshop, not a national-level exercise. Moreover, it mentions a "Strategic (Public Health) Risk Assessment in October 2023" (p.32), but this is an assessment activity, not a full-scale exercise. ³¹⁷

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ^318319320

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

Score: 0

There is no evidence that Seychelles has identified gaps and best practices in response to infectious disease threats, biological threats, or other public health emergencies within the past year. Additionally, there is no confirmation that a plan has been developed within this period to improve response capabilities based on such an exercise.

The Annual Health Sector Performance Report 2023 explicitly states: "The country also undertook a Strategic (Public Health) Risk Assessment in October 2023, using the Strategic Toolkit for Assessing Risk (STAR), which helped identify priority health threats in the Seychelles context" (p.32). Identifying "priority health threats" inherently involves recognizing areas where current response capabilities might be insufficient or need strengthening, thus pinpointing gaps. ³²¹

The broader plan to improve response capabilities is encapsulated in the National Health Strategic Plan (NHSP) 2022-2026. ³²² The Annual Health Sector Performance Report 2023 details the progress and ongoing implementation of this plan during 2023: "Two years through implementation of the National Health Strategic Plan (NHSP 2022-2026), the Ministry of Health (MOH) has made progress towards its goals and objectives… leading to positive outcomes… managing health emergencies" (p.3). ³²³ The NHSP includes a specific strategic direction, "SD3 Improve Health Security," with the general objective "To promote and protect health security… in collaboration with national and international partners… [and] strengthen public health programmes" (p.57). ³²⁴

Furthermore, direct activities in 2023 aimed at improving response include: "MOH hosted the 3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs) from 2nd-14th May 2023… The main objective was strengthening PHEOCs in respective countries including through training of others at sub-national levels in incident and PHEOC management" (p.32). This training directly aims to improve response capabilities by strengthening the management of public health emergencies. The report also indicates that "The International Health Regulations (IHR) core capacities index improved from 53 in 2022 to 55 in 2023" (p.5). This improvement indicates ongoing efforts to enhance preparedness and response measures as per international standards, which includes addressing identified weaknesses. While the report does not detail a specific "after action review" or a "biological-threat focused exercise" completed in 2023, the Strategic Risk Assessment in October 2023 serves as an explicit identification of threats (gaps) for which the country's ongoing strategic plan (NHSP) and associated training (PHEOCs in May 2023) are designed to improve response capabilities. ³²⁵

Prior activities in 2023 highlight important efforts toward health security improvement but do not qualify under the specified timeframe. A recent review of the WHO Strategic Preparedness and Response Portal (SPRP) does not contain any evidence or reporting indicating that Seychelles has conducted updated activities in the past year to identify gaps or best practices through infectious disease response reviews, after-action reviews, or biological threat-focused simulations. ³²⁶

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

Score: 0

There is no evidence that the country has undergone a national-level biological threat-focused exercise that included private sector representatives in the past year.

While the Annual Health Sector Performance Report 2023 mentions several activities related to preparedness and engagement, it details a "3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs) from 2nd-14th May 2023" (p.32). This was a training event, not described as a national-level exercise simulating a biological threat. It refers to a "Strategic (Public Health) Risk Assessment in October 2023" (p.32). This is an assessment activity, not an exercise. The report also notes participation from the "private health sector" in a "National Digital Health Maturity Assessment (DHMA)" which took place from October 17th to 20th, 2023 (p.16). However, this was an assessment of digital health maturity, not a biological threat-focused exercise. ³²⁷

Other national documents, such as the National Health Strategic Plan 2022-2026, Joint External Evaluation 2018, and 2023 Annual Hospital Services Statistical Report, do not contain information about such an exercise. ^328329330

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

The country has an Emergency Operations Center (EOC) in place, specifically referred to as a National Emergency Operations Centre (NEOC) for broader national coordination and a Public Health Emergency Operations Centre (PHEOC) for health-specific emergencies.

The Joint External Evaluation (JEE) report explicitly states that "Seychelles has a Disaster Risk Management Act and a National Emergency Operations Centre (NEOC), located at DRDM, for national coordination of emergencies" (p. 37). This NEOC serves as a central location for coordinating operational information and resources for strategic management of emergencies (p. 37). The JEE also includes a recommendation to "Develop and operationalize plans and SOPs for a public health emergency operations centre (PHEOC)" (p. 37), indicating a specific focus on establishing and formalizing a public health-dedicated EOC. ³³¹

The Seychelles National Integrated Emergency Management Plan (NIEMP) further details the role of the NEOC within its incident command system. At the "Gold level—national coordination," the National Emergency Operations Centre (NEOC) is described as "the facility established to support a Unified Command" and includes "a comprehensive Command Staff and General Staff structure to assist in the effective management of any emergency" (p. 29). The plan indicates that for Level 3 national emergencies, "the establishment of NEOC and appropriate Silver Command posts" will be activated, and for Level 4 significant national emergencies, there will be "full activation of NEOC and appropriate Silver Command posts" (p. 33, 34). The NIEMP also mentions a "Humanitarian Assistance Module of the National Emergency Operations Center" as part of its international cooperation coordination (p. 51). ³³²

The National Health Strategic Plan (NHSP) 2022-2026 confirms the operational involvement of a Public Health Emergency Operations Centre (PHEOC), listing it as an acronym (p. XI). The document also refers to the PHEOC as having "reported only 116 deaths during the same period, ‘directly’ caused by COVID-19 through their assessment" in 2021, indicating its active role during the COVID-19 pandemic (p. 21). The NHSP further designates the PHEOC as a responsible entity for monitoring COVID-19 related indicators (p. 118). ³³³

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

Score: 100

The country has a requirement for its Emergency Operations Center (EOC) to conduct drills, and there is evidence of such exercises taking place.

The Seychelles National Integrated Emergency Management Plan (NIEMP) explicitly states that the Department of Risk and Disaster Management (DRDM), which houses the National Emergency Operations Centre (NEOC), is mandated to organize and execute various drills. Specifically, section 4.1, point 10, outlining the statutory responsibilities for DRDM, includes the task to "Organize and execute various drills, and functional and full-scale exercises annually" (p. 19). This clearly establishes an annual requirement for conducting exercises involving the national emergency management structure, which includes the NEOC. Furthermore, the NIEMP indicates that DRDM "should conduct frequent exercises to test all or parts of the NIEMP" and that these exercises "may include national and district representatives, as well as NGO and private sector organisations that have a role in coordinating emergency activities with the government" (p. 39). ³³⁴

The Joint External Evaluation (JEE) report from March 2018 provides further evidence of drills and tests for preparedness plans, although it notes a different frequency for public health plans at the time of the evaluation. The JEE states that "A public health emergency preparedness and response plan is in place, and is tested every two years through tabletop and functional exercises" (p. 35). It also mentions that "Simulation exercises take place frequently to test guiding documents, equipment, staff and coordination" (p. 37). The JEE report highlights that "Exercises have been conducted between the Public Health Authority and the security forces, organised through the DRDM," and that "after these exercises the agencies debrief, prepare reports and review recommendations for improvements" (p. 39). While the JEE noted that some plans were tested biennially for public health in 2018, the later NIEMP (2019-2024) establishes an annual mandate for DRDM's exercises, suggesting an updated and more frequent requirement for comprehensive drills involving the NEOC. ³³⁵

Evidence from a World Bank document, the "Seychelles Disaster Risk Management Development Policy Loan Project," confirms that this annual target has not only been met but significantly exceeded. With a baseline of zero drills in 2014, the target was set for one exercise per year, yet a total of 16 drills and exercises were delivered between 2015 and 2020. This consistent practice has enhanced the capacity of both governmental and sectoral agents to respond effectively to disasters. Specific public health emergency drills conducted include a pandemic drill in 2018, which involved the tourism sector, the Red Cross Society of Seychelles, and the Ministry of Health. Furthermore, in March 2020, DRDM and the police department successfully carried out a test exercise simulating Seychelles' preparedness for the evolving COVID-19 infection situation, demonstrating the practical value of the NIEMP in real-world public health contexts. These exercises, including NIEMP Table Top Exercises (TTX) with the NEOC, have consistently tested multi-agency coordination, communication arrangements, incident command management, and tactical capabilities at national and district levels, thereby strengthening the country's overall disaster risk management framework. ³³⁶ While the Joint External Evaluation (JEE) report from March 2018 indicated a biennial testing schedule for public health emergency plans at that time (p. 35), the subsequent data clearly demonstrates the country's proactive move towards a more frequent and robust exercise schedule, affirming the annual requirement and its successful implementation for public health emergency preparedness. ³³⁷

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

Score: 0

There is no public evidence that the Emergency Operations Center (EOC) in Seychelles has conducted, within the last year, a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of a public health emergency/scenario.

The Joint External Evaluation (JEE) report, under the "RESPOND" section for "Emergency response operations," states a target: "Country has capacity for: a public health emergency operations centre… capable of activating a coordinated emergency response within 120 minutes of the identification of a public health emergency" (p.36). The 2018 report itself noted areas that needed strengthening, such as developing SOPs for EOC activation (p.37). ³³⁸ The National Health Strategic Plan (2022-2026) also outlines objectives for "SD3 Improve Health Security," including "Establish mechanisms for detecting and responding to public health threats and events or emergencies" (p.58). ³³⁹

The Annual Health Sector Performance Report 2023 mentions that "MOH hosted the 3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs) from 2nd-14th May 2023" (p.32). This indicates an effort to strengthen PHEOC capabilities through training, but it is a training event, not an exercise or actual response by Seychelles' EOC, and it does not provide details on activation times for any response or exercise. ³⁴⁰

The Annual Health Sector Performance Report 2023 describes a significant emergency response to an explosion: "The 7th December explosion triggered a strong emergency health response, with mobilisation of additional resources to tend to the casualties – 139 patients were seen within the first 6 hours – all treated with no deaths" (p.4). The report further elaborates that "A health incident management command was activated ad three health facilities… were alerted to cater for potential victims… Within four hours of the incident, 139 patients from the incident were seen" (p.44). While this demonstrates a coordinated emergency response to a disaster, it refers to the activation of a "health incident management command," not explicitly the national EOC/PHEOC. It also notes that patients were seen "within four hours," which is 240 minutes, exceeding the 120-minute criterion for activation. ³⁴¹

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no explicit public evidence of standard operating procedures, guidelines, or agreements that specifically address response to a deliberate biological event, such as a bioterrorism attack. Terms like "bioterrorism" or "deliberate biological event" are absent. However, existing documents provide frameworks for broader public health threats, biosecurity emergencies, and illegal biological movements, which would likely underpin any response to high-impact biological incidents.

The Animal and Plant Biosecurity Act, 2014 establishes a framework to prevent the entry and spread of pests and diseases in Seychelles (p.253). It mandates a designated agency to prepare a Biosecurity Emergency Response Plan in consultation with the National Disaster Committee (p.273). The Act emphasizes a "Duty to coordinate and cooperate" (p.305), requiring border, customs, health, and security officers to work together. Police and other ministries may be mobilized during biosecurity emergencies (p.359), though not specifically for deliberate events. ³⁴²

The Biosecurity Operational Manual (2011) outlines SOPs for inspections, cargo clearance, and handling of high-risk materials (p.4–7). While focused on invasive species and accidental introductions, it stresses that "Preventing the passage of species across borders is the most cost-effective way" (p.4). ³⁴³

The Final Draft National Biosafety Framework addresses GMOs, applying a "precautionary principle" (p.1, p.38). It outlines enforcement mechanisms against illegal transboundary movements (p.46), involving multiple inspectorate bodies, but does not frame this as bioterrorism. ³⁴⁴

The Annual Health Sector Performance Report 2023 highlights training on Public Health Emergency Operations Centres (p.32), surveillance systems (p.38), and the response to the December 7th explosion (p.4, p.44), showing capacity for multi-sectoral crisis response, though not deliberate biological events. ³⁴⁵

Finally, the National Health Strategic Plan 2022–2026 prioritizes "SD3 Improve Health Security" (p.III, p.55), promoting a One Health approach, IHR implementation, and multi-sectoral partnerships. While robust for general outbreaks, no document details protocols for a "deliberate biological event" or "bioterrorism attack." ³⁴⁶

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

Score: 100

The country has in place sections detailing a risk communication plan specifically intended for use during a public health emergency.

The Joint External Evaluation report for Seychelles confirms that the national and subnational risk communication core capacity is currently robust, largely due to strong commitment within various relevant ministries, departments, and agencies (p. 44). This capacity has been further bolstered by the development of a risk communication strategic plan, which was created with the assistance of a WHO consultant (p. 44). Additionally, a multisectoral working group dedicated to risk communications was established, and this group successfully developed and implemented a comprehensive national plague risk communication plan (p. 45). This plan was collectively put into action by all participating members of the working group, demonstrating clear definitions of stakeholder functions that support coordinated communication efforts (p. 45). ³⁴⁷

In alignment with these efforts, the Seychelles National Integrated Emergency Management Plan (NIEMP), within its Functional Area V: Emergency Management, specifically includes Task 5.2, designated as "Public Information" (p. 50). The primary purpose of this task is to ensure that the population receives timely information and recommendations concerning the impact of an emergency and the subsequent response actions (p. 50). Its operational scope covers understanding the post-event scenario, preparing press releases, establishing information chains, and devising communication strategies and citizen awareness campaigns for risk prevention (p. 50). The NIEMP also details that Gold Level Commanders are responsible for formulating and implementing media-handling and public communication plans during an emergency (p. 29). This is part of a broader Incident Command System that ensures coordinated communication and decision-making across various levels of emergency response (p. 26). ³⁴⁸

Furthermore, the National Health Strategic Plan (NHSP) 2022-2026 highlights the importance of communication in strengthening governance and leadership. It acknowledges weaknesses in information flow within and across Ministry of Health (MoH) entities and with other sectors, emphasizing the need for mechanisms to ensure clear and timely communication (p. 40). To address this, Specific Objective 1.4 in the NHSP focuses on implementing an effective coordination and communication system, with key interventions including developing formal coordination mechanisms and communication strategies (p. 44). The NHSP also aims to engage the community by disseminating findings from annual performance reports and other important documents to obtain feedback, and to build community leadership for priority health conditions (p. 45). The plan also identifies a gap in its "Outstanding Issues" regarding communication strategy for addressing risks to health, noting that a coordinated advocacy and communication plan for reaching communities and households is not yet in place, but that communication strategies are needed for behavioral, environmental, and metabolic risk factors (p. 64). ³⁴⁹

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 also significantly contributes to the country's risk communication capabilities, particularly concerning infectious disease emergencies. The framework states that an effective IPC system encompasses solutions grounded in infectious diseases, epidemiology, social science, and health system strengthening, and aims to achieve evidence-based IPC standards for effective management of public health emergencies (p. 5). The framework's objectives include ensuring the availability of evidence-based national IPC guidance documents for managing public health emergencies (p. 13). Notably, Section 10.4.4, titled "Promote public awareness and education on infection prevention and control practices," explicitly states the importance of public awareness and knowledge about behavioral changes to prevent and control infections (p. 19). It mandates a comprehensive plan for client/patient/community information and education, with key activities involving liaison with the Health Promotion Unit and NGOs to develop and implement a national communication strategy, including campaigns for public awareness and support for IPC, using tailor-made communication materials (p. 20). These efforts involve using community meetings, open days, circulars, conferences, seminars, and electronic and print media to educate and raise awareness (p. 20). The framework also outlines a key activity to institute yearly assessments of public knowledge and satisfaction with IPC practices (p. 20). Furthermore, it notes that the country has an emergency preparedness and readiness plan that includes IPC interventions and addresses communication (p. 10). ³⁵⁰

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

Score: 100

The risk communication plans and guiding documents in Seychelles outline how messages will reach populations and sectors with different communication needs, including various locations, media preferences, and vulnerable groups.

The Joint External Evaluation (JEE) report acknowledges that risk communication should be a "multilevel, multifaceted process" (p. 44). It highlights that communications with communities are facilitated by "district health councils that include priests, councillors, local people of influence, and others" (p. 44). This approach targets specific locations and leverages local trusted figures to ensure messages resonate with community members. The JEE also notes that "traditional media—such as radio—has wide coverage and is used to assist in rumour management," while new channels, including "social media channels," have been activated, particularly following the 2017 plague outbreak (p. 44). Furthermore, the JEE outlines that "regular briefing, training and engagement of social mobilization and community engagement teams, including volunteers" are in place, with "mechanisms to scale up" being operational, demonstrating efforts to reach affected and hard-to-reach communities directly (p. 46). A feedback loop based on listening to community engagement is also in place and operational, tested during the plague outbreak (p. 46). However, the JEE also points out areas for improvement, such as improving "health workers’ access to messages… in order to ensure timely, uniform messaging" for those interacting directly with communities, addressing a challenge in consistent information delivery to all parts of the population (p. 46). ³⁵¹

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 explicitly states the need for a "comprehensive plan for client/patient/community information and education" (p. 19). Key activities under this framework include developing and implementing a "national communication strategy, including campaigns to promote public awareness and support for IPC," and specifically calls for "wide dissemination of tailor-made communication materials such as posters and fliers on IPC" (p. 20). To reach different populations, it specifies that "patient, client and community education and awareness creation could be through community meetings, open days, circulars, conferences, seminars and other electronic and print medias" (p. 20). ³⁵²

The National Health Strategic Plan (NHSP) 2022-2026, while not detailing specific communication methods for diverse groups as extensively as the IPC framework, underscores the importance of "engag[ing] the community" by incorporating "community consultation in the development process of all health policies/strategies and understand[ing] their values and preferences" (p. 44). This commitment to understanding community perspectives inherently supports the development of tailored messages. The NHSP also identifies the need to "Address discrimination and protect rights of vulnerable population groups (substance abuse, mental health, social ills)" and aims to develop "targeted interventions to reach vulnerable populations" (p. 50). Although focused more on service access, this directly implies an understanding that vulnerable groups have specific needs that communication strategies should address. Additionally, the NHSP recognizes that "communication strategies are needed to address behavioural, environmental, and metabolic risk factors," indicating an awareness of the need for targeted messaging based on health risks (p. 64). ³⁵³

The Seychelles National Integrated Emergency Management Plan (NIEMP) supports these efforts by including "Public Information" as a functional task, aiming to provide the population with "timely information and recommendations" through "communication strategies and citizen awareness strategies for risk prevention" (p. 50). While this document does not detail specific tailoring methods for different communication needs, its overarching goal of informing "the public" and "citizens" implies a need for accessible and effective messaging across the population (p. 50). ³⁵⁴

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

Score: 100

The risk communication plan and other guiding documents indicate that specific positions within the government are designated to coordinate public communication during a public health emergency, which serves as a central point for media interaction.

The Joint External Evaluation (JEE) report for Seychelles notes that "The Ministry of Health communications structure in Seychelles is managed through the public relations officer, who coordinates communication for the whole Ministry of Health" (p. 44). Furthermore, it states that "the MOH health promotion manager coordinates risk communication" (p. 44). The document specifies that "The person responsible for this task directs the media to relevant sections of the ministry and helps to bring all risk communication actors in government (including DRDM and the Ministry of Tourism) under the same roof" (p. 44). ³⁵⁵

The Seychelles National Integrated Emergency Management Plan (NIEMP) details that at the "Gold level—national coordination," commanders are responsible for formulating and implementing "media-handling and public communication plans, potentially delegating this to one ministry or responding agency" (p. 29). Task 5.2, "Public Information," within the NIEMP is also led by the Department of Risk and Disaster Management (DRDM), with support from other entities, further outlining the institutional arrangements for public communication (p. 50). ³⁵⁶

While the National Health Strategic Plan (NHSP) 2022-2026 does not name a specific spokesperson, it highlights the need for effective communication and advocates for a coordinated advocacy and communication plan (p. 64) and focuses on "implement[ing] effective communication strategies" (p. 44). ³⁵⁷

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 also mentions liaising with the "Health Promotion Unit" to develop and implement a national communication strategy, further pointing to the Health Promotion Unit's role in public communication regarding health issues (p. 20). ³⁵⁸

Therefore, while the term "primary spokesperson" might not be used in isolation, the documents collectively designate the Public Relations Officer and the Health Promotion Manager within the Ministry of Health, along with the Department of Risk and Disaster Management, as key coordinating positions responsible for public and media communication during public health emergencies.

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

Score: 100

There is evidence that the public health system in Seychelles has actively shared messages via online media platforms to inform the public about ongoing public health concerns.

The Annual Health Sector Performance Report for 2023 indicates that the Ministry of Health (MOH) is aware of challenges such as the "pervasive spread of misinformation" (p.3). To address this and disseminate information, the MOH regularly updates its official website with various key reports and policies (p.16). Furthermore, the Health Promotion, Media and Communication Unit maintained high engagement on the MOH Facebook and Instagram pages throughout 2023, publishing regular posts. At the end of January 2024, the Facebook page had 164,500 followers and achieved a reach of 54,800 people in the preceding 28 days with 605 content interactions. The Instagram page had 3,800 followers and reached 1,800 people in the same period with 116 content interactions (p.62). These online platforms were utilized to keep the public informed about current health sector performance, achievements, challenges, and key sector policies, which implicitly contributes to countering misinformation by providing accurate and official health information. ³⁵⁹

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

Score: 100

There is no evidence to suggest that senior leaders, such as the President or Ministers, have shared misinformation or disinformation on infectious diseases in the past two years.

The Annual Health Sector Performance Report for 2023 acknowledges that a significant global challenge is the "pervasive spread of misinformation" (p.3), and it also notes that "Vaccine conspiracy and anti-vaccine movements remain a persisting and growing challenge to the continued effectiveness of the EPI in Seychelles" (p.58). However, the report consistently portrays senior leaders as actively engaged in promoting public health initiatives and providing accurate information. For instance, the President of the Republic launched the National Stop Obesity campaign in October 2023 (p.14), and the Minister of Health regularly addressed questions in the National Assembly covering a wide range of health topics (p.15) and led country delegations to international health meetings, such as the 76th World Health Assembly (p.14). The Ministry of Health also actively shares messages via online platforms like Facebook and Instagram to inform the public about ongoing public health concerns (p.62), which serves to counter misinformation by providing official communications. These actions indicate efforts to address public health concerns and disseminate accurate information, rather than contributing to misinformation or disinformation. ³⁶⁰ No results returned from media outlets in regards to seniors leaders in Seychelles spreading health misinformation.

3.6.1a Percentage of households with Internet

Score: 71.84

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 100

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 Seychelles 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. ^361362363

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

Score: 100

There is no publicly available evidence indicating that Seychelles 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. ^364365366

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

Score: 100

There is no publicly available evidence indicating that Seychelles 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. ^367368369

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

Score: 100

Seychelles does utilize a risk-based approach to international travel-related measures.

The Biosecurity Operational Manual emphasizes the use of a "Risk Analysis Matrix" (p.4) to determine pathways, items, and personnel, allowing for the identification of "high risk materials or people" (p.5). This enables appropriate measures to be taken to reduce the potential for introduction of pests, diseases, or Invasive Alien Species (IAS) (p.5). The manual also notes that "Most passengers, baggage, commercial and non-commercial articles and consignments pose little risk to the biosecurity of Seychelles. The general principle recommended is that there is minimal risk, until a profile is developed which indicates that a pathway is being used" (p.5). This highlights an adaptive, risk-informed strategy. Furthermore, Attachment 3 of the manual, "Risk Profiles of Airport and Seaport Passengers entering the Seychelles," directly categorizes different types of passengers (e.g., Seychellois returning from overseas, guest workers, tourists) and their associated "Risk items likely to be carried" and corresponding "Risk level" (p.39). For instance, Seychellois returning from overseas are deemed "Likely" to carry risk items, while high-end tourists are considered "Rare" risk (p.39). This structured profiling directly informs travel-related biosecurity measures. ³⁷⁰

The National Health Strategic Plan (NHSP) 2022-2026, under "SD3 Improve Health Security," outlines objectives such as implementing the International Health Regulations (IHR) to prevent, detect, and manage outbreaks (p.58). ³⁷¹ The IHR framework, as noted by the UNWTO and WHO, specifically advises that "all measures applied to international travellers should be based on 'risk assessments – including testing, isolation and vaccinations'". ³⁷² Seychelles' commitment to implementing the IHR (p.58) implies an adherence to these risk-based principles. ³⁷³ The Annual Health Sector Performance Report for 2023 further confirms this, stating that the International Health Regulations (IHR) core capacities index improved from 53 in 2022 to 55 in 2023 (p.6, p.64), indicating ongoing efforts to align with international health security standards that underpin risk-based travel measures. The report also mentions the PHA's role in inspecting sea vessels and aeroplanes for public health risks, including "sick passengers/crew and invasive species" (p.37), demonstrating active risk management at points of entry. ³⁷⁴

4.1.1a Doctors per 100,000 people

Score: 100

4.1.1b Nurses and midwives per 100,000 people

Score: 100

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

While Seychelles acknowledges the critical importance of human resources for health and has components related to workforce development, a comprehensive and updated national health workforce strategy (developed or updated within the past five years) that specifically identifies insufficient fields and outlines concrete strategies to address these shortcomings is not yet fully in place, but is a significant priority for current development.

The National Health Strategic Plan (NHSP) 2022-2026, which was published in June 2022 (within the last five years), extensively discusses the state of the health workforce. It identifies "Human Resources for Health" (HRH) as one of the critical inputs for effective health service delivery under Strategic Direction 5: "Invest for Results" (p. 69). The NHSP highlights several outstanding issues concerning the health workforce. "The Seychelles health system is heavily dependent on foreign health workers. Fifty-seven per cent of all health professionals are expatriates and 64% are trained abroad" (p. 70). "There is no clear policy on recruitment, especially for foreign HCW. Unnecessary bureaucracy delays the employment of identified personnel" (p. 71). There is a "lack human capacity for health economics, disease surveillance, health regulation, data governance and monitoring and evaluation" (p. II). "The sector does not systematically collect, analyse and use HR data to guide training, recruitment, deployment of staff" (p. 71). "Key positions in the sector remain unfilled due to poor succession planning" (p. 71). ³⁷⁵

Crucially, the NHSP 2022-2026 explicitly lists "Develop a national Human Resources Strategic Plan" as the top priority area in HRH (p. 71). Under its specific objectives for SD5, the plan details a key intervention: "Develop National Human Resources for Health Strategic Plan" with the milestone being that it is "developed and implemented" (p. 78). This indicates that while the need is recognized and strategies are being planned, the comprehensive, updated HRH strategy itself is a future output of the current NHSP period. ³⁷⁶

Earlier, the Joint External Evaluation (JEE) report from 2018 also noted the need for a focused workforce strategy. While acknowledging a "national public sector plan for human resources (ANHRD National Plan)" and the "National Health Strategic Plan 2016-2020 contains projections for investment in human resource development," the JEE also stated, "Although there are national plans addressing human resources for health, there are no focused plans or strategies to develop the public health workforce" (p. 33). The JEE recommended to "Develop a public health workforce strategy that addresses identified gaps in existing human resources in the human, animal and environmental health sectors, and which emphasizes cross disciplinary working by a multi-skilled public health workforce" (p. 32). ³⁷⁷

No relevant evidence was found on the website of the Ministry of Health. ³⁷⁸

4.1.1d Health system capacity for essential health services

Score: 0

There are challenges and recognized insufficiencies in Seychelles's capacity to fully deliver all essential health services effectively and sustainably.

The National Health Strategic Plan (NHSP) 2022-2026, despite noting that Seychelles delivers health services as a high-income country, identifies "several weaknesses and gaps" within the health system. It states, "The country has invested in human resources for health, however, there is still reliance on expatriates for clinical care and there is a lack human capacity for health economics, disease surveillance, health regulation, data governance and monitoring and evaluation" (p. II). The NHSP explicitly points out that "While it is true that the sector lacks some critical inputs, it is also true that it does not always succeed to transform inputs into results. The service delivery model has remained rigid over many years and digital technology is not used adequately to improve services" (p. II). ³⁷⁹

More specifically, capacity gaps are evident across several areas. There is a "heavy dependence on foreign health workers," with "Fifty-seven per cent of all health professionals are expatriates and 64% are trained abroad" (p. 70). Key positions remain unfilled due to poor succession planning, and there's a lack of quality data to inform HR planning. Staff morale and well-being are impacted, with healthcare workers "under considerable strain" and experiencing burnout, particularly exacerbated by the COVID-19 pandemic (p. 71). Moreover, many health facilities are "dated and may not meet ideal requirements for modern standards of care delivery." There are "many safety risks [that] remain chronically unaddressed – fire, flood, storm, chemical, biological and radiological." Weak preventive maintenance systems lead to delayed repairs, and "safe storage space is a major challenge" (p. 30). A comprehensive "Seychelles Hospital Masterplan" exists but "is yet to be implemented," indicating a lag in critical infrastructure development (p. 30). ³⁸⁰

While spending on health has increased, the current financing model is deemed "not sustainable in the long run," especially given the rising costs from non-communicable diseases (NCDs), obesity, an aging population, and new technologies. Spending is "skewed towards curative care, especially specialised care," with less investment in preventive and primary care. Challenges also exist with cost-efficiency, lack of cost-benefit awareness, and weak revenue collection systems (p. 72-73). Furthermore, the health system experiences "occasional stock-outs of certain medicines and supplies" and a need for "more effective in-country stock-management and distribution." Maintaining advanced medical equipment is also a challenge, and donated supplies are not always "tailored to needs and/or are not of adequate standard/quality" (p. 30). While public healthcare is "widely accessible geographically, and without financial barriers," quality, equity, outcomes, and user satisfaction are "not adequately measured." There's a "weak clinical governance model," "relative neglect of preventive, promotive and long-term care services," and "referral systems are weak" (p. 31). Language barriers, stemming from the reliance on an immigrant health workforce, also pose a chronic challenge (p. 31). ³⁸¹

The IPC Strategic Framework also notes "Inadequate human resource to ensure appropriate staffing levels at all times" and "Ensuring sufficient equipment and supplies to deliver the IPC recommendations" as major IPC challenges (p. 12). ³⁸² The Joint External Evaluation (JEE) report also noted "inadequate human resource capacity in animal health" and a "critical shortage of veterinary manpower" (p. 15, 32). ³⁸³

No relevant evidence was found on the website of the Ministry of Health. ³⁸⁴

4.1.1e Essential health services continuity plan for public health emergencies

Score: 100

Seychelles has a plan in place to ensure the continuity of essential health services during a public health emergency.

The National Health Strategic Plan (NHSP) 2022-2026 explicitly addresses this critical need, particularly in light of the COVID-19 pandemic. Under Strategic Direction 2, which aims to protect and improve Universal Health Coverage and build resilience, a key intervention is to: "Finalise and implement the Continuity of Essential Health Services (CEHS) plan", and "Define essential health services; ensure their continuity" (p. 54). The NHSP acknowledges that the COVID-19 pandemic led to many services being "temporarily interrupted," and aims to address this by institutionalizing COVID-19 response functions and defining essential services to ensure their continuity (p. 31, 54). Furthermore, mitigation strategies for the risk of a "protracted public health emergency" include the development of a plan for the "continuation of services in case of emergencies" and defining "essential services" (p. 102). ³⁸⁵

Beyond this specific CEHS plan, other documents provide a broader framework for maintaining services during crises. The Seychelles National Integrated Emergency Management Plan (NIEMP) includes national priority goals such as "Assure coverage of people’s basic needs" and "Promote swift restoration of normal life" during emergencies (p. 4). ³⁸⁶ The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 aims for a health sector with "enough capacity to assure patient safety, quality of care and resilient to rapidly recover from the impact of public health emergencies," indicating an overarching goal to ensure health system functionality during crises (p. 5). ³⁸⁷ The Joint External Evaluation (JEE) report notes that the country has an emergency preparedness and readiness plan that includes IPC interventions, covering aspects such as roles and functions of different agencies, training, surveillance, logistics, communication and surge capacity. The JEE also highlights Seychelles' "strong sense of national resilience" and "nationally funded health system" with "secured funds for public health response activities," which are foundational for supporting continuity plans (p. 43). ³⁸⁸

4.1.2a Hospital beds per 100,000 people

Score: 85.33

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

Score: 100

Seychelles has existing capacity for patient isolation in designated rooms and temporary facilities, but a purpose-built, permanent biocontainment patient care unit for highly communicable diseases is identified as an ongoing need and a future development goal.

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 states that "Isolation wards/units or holding areas with recommended facilities are available in most health care facilities but adherence to isolation precautions is not encouraging" (p. 9). During the COVID-19 pandemic, "The MoH provided temporary structure for screening/triaging. The country has further established a temporary isolation hospital for the treatment of COVID-19 cases" (p. 10). ³⁸⁹

The Joint External Evaluation (JEE) of IHR Core Capacities report from 2018 noted that "a purpose-built isolation facility is planned" (p. 9). ³⁹⁰ The National Health Strategic Plan (NHSP) 2022-2026 explicitly lists "Need for purpose-build dedicated Isolation infrastructure" as an "Outstanding issue" (p. 74). Under the strategic objective to "Invest for Results," the NHSP sets a milestone to "Address increased infrastructure needs for high-care and infectious-disease isolation" with the goal of having a "Dedicated purpose-built Isolation Unit ready" (p. 83). The NHSP further highlights the objective under "SD2 Protect and Improve Universal Health Coverage" to "Institutionalise COVID-19 services and build resilience," which includes the need to "Ensure continued, dedicated isolation and treatment capacity" (p. 54). ³⁹¹ The IPC Strategic Framework also refers to "plans to erect permanent structure for these services" (p. 10). ³⁹²

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ^393394395

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

Score: 100

Seychelles has demonstrated capacity to expand its critical care, which is crucial for isolation, and has engaged in activities related to developing, updating, or testing plans for infectious disease outbreaks within the past two years.

The Annual Health Sector Performance Report 2023 explicitly details an expansion of the Intensive Care Unit (ICU) capacity in 2023. Under the "Inpatient Care" section, it notes a persistent issue of over-occupancy in the ICU, stating: "In view of the persistent over-occupancy, ICU was relocated to a location that can accommodate 14 patients. This required further shifts of Male Medical Ward and Maternity 2 (post-natal) ward in 2023" (p.49). While this expansion is attributed to general over-occupancy rather than an explicit infectious disease outbreak, increasing ICU beds to 14 significantly enhances the healthcare system's ability to isolate and manage critically ill patients, including those with severe infectious diseases requiring intensive isolation measures. This relocation and expansion occurred within the specified two-year timeframe. ³⁹⁶

The report details several activities that fall under developing, updating, or testing emergency preparedness plans. "In the area of public health, the MOH hosted the 3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs) from 2nd-14th May 2023, in collaboration with key international partners. Forty-two participants from 27 countries and regional bodies across Africa participated in this training. The main objective was strengthening PHEOCs in respective countries including through training of others at sub-national levels in incident and PHEOC management" (p.32). Training on PHEOC management is directly related to planning and coordinating responses to public health emergencies, including those involving infectious disease outbreaks and the need for isolation. ³⁹⁷

The country "also undertook a Strategic (Public Health) Risk Assessment in October 2023, using the Strategic Toolkit for Assessing Risk (STAR)" (p.32). This type of assessment helps identify potential health threats, including infectious diseases, and informs the development or updating of response plans, which would incorporate isolation strategies. ³⁹⁸

The report mentions that "The International Health Regulations (IHR) core capacities index improved from 53 in 2022 to 55 in 2023" (p.5). This improvement indicates ongoing efforts in strengthening various aspects of preparedness and response, which inherently involve reviewing and updating plans for managing infectious diseases, including isolation protocols. ³⁹⁹

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

Score: 0

There is limited evidence that a procurement protocol and contract framework are in place within the Ministry of Health (MoH), but no documentation supports the existence of a joint framework or protocol used by both the Ministry of Health (MoH) and the Ministry of Agriculture (MoAg) for the acquisition of supplies for routine needs. This absence significantly affects the comprehensiveness of the national procurement framework for health and agriculture-related supplies.

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 does indicate the existence of a procurement system within the Ministry of Health. It states that a "procurement, stores and supplies management system has improved at the central level" (p. 10-11), referencing a functioning system. Furthermore, plans are detailed to "develop and integrate standardized list of IPC supplies and equipment into routine health and logistics management system" (p. 23), indicating efforts to refine and improve an established process for laboratory and medical supplies. However, this framework does not clarify how these improvements might apply to or align with efforts in the Ministry of Agriculture. ⁴⁰⁰

The Joint External Evaluation (JEE) of IHR Core Capacities report from 2018 also supports the existence of a procurement process within the Ministry of Health. It notes that "procurement of medical supplies is financed entirely through government budgets. The country procures medicines based on the current list of essential medicines, which covers prevalent conditions and diseases as identified by the Ministry of Health" (p. 42). The report further states that a minimum stock of three months’ worth of drugs and consumables is maintained at the Central Medical Stores (CMS), highlighting a structured government-backed procurement process. However, the JEE does not provide evidence of collaboration between the MoH and the MoAg on this system or similar procurement activities. ⁴⁰¹

The National Health Strategic Plan (NHSP) 2022-2026 acknowledges the need to strengthen procurement processes, stating an objective to "revise the procurement process to avoid stock-outs" (p. 76). Additionally, "Strengthen procurement and stock management capacity" is listed as a key intervention under the “Health Technologies” section (p. 82). However, these revisions and interventions focus on MoH processes and do not mention inclusion or coordination with the Ministry of Agriculture for procurement activities related to zoonotic diseases or One Health approaches. ⁴⁰²

The absence of joint procurement protocols becomes especially significant when considering the interconnectedness of human, animal, and environmental health under the One Health approach. For zoonotic diseases and other health threats that require collaboration between human and animal health sectors, an integrated procurement system used by both the MoH and MoAg would ensure more efficient management of laboratory supplies, reagents, personal protective equipment (PPE), and other essential resources.

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

Score: 33.33

There is evidence that some minimum stockpiles exist and that plans to improve procurement and stock management are priorities within the health sector.

According to the Joint External Evaluation (JEE) report (2018), Seychelles does not maintain a formal national MCM stockpile. However, "a minimum stock of three months’ worth of essential drugs and consumables (such as doxycycline, cotrimoxazole, ciprofloxacin, etc., for managing plague outbreaks) is maintained at the Central Medical Stores (CMS). This is also regarded as a buffer stock for epidemic response." (p. 42). ⁴⁰³

The NHSP acknowledges that the COVID-19 pandemic "brought to light just how critical these inputs are to the daily operations of the health system" (p. 69). It states that "restrictions in international air travel, depreciation of the Seychelles rupee, and in-country lock-downs in source countries severely compromised the procurement of medicines and medical products" (p. 70). Under SD5, "Invest for Results," the NHSP addresses "Health Technologies," including medicines and medical devices (p. 74). Outstanding issues include "Lack of regulatory framework for health technologies," "Stock outs of medicines and commodities," and "The Procurement Unit does not involve service providers in prioritisation exercises" (p. 74). ⁴⁰⁴

Priority areas in Health Technologies include: "Strengthen procurement and stock management capacity" (p. 75); "Digitalise Stock management" (p. 75); "Develop an essential list of health technologies commensurate with the health service package" (p. 83); "Revise essential medicines list taking into account new evidence-based treatment guidelines for priority NCDs" (p. 83); "Introduce new health products" (p. 83). ⁴⁰⁵

While these interventions are aimed at improving the availability and management of health products, the document does not explicitly confirm the existence of a dedicated national stockpile of medical supplies (including MCMs, vaccines, medical equipment, PPE) specifically defined for use during a public health emergency by the overarching plan. It highlights the need to improve stock management and forecasting (p. 33). The mention of "safe storage space" as a challenge (p. 30) further suggests that a comprehensive, dedicated emergency stockpile system is an area requiring development. ⁴⁰⁶

The NHSP emphasizes "equity in access to health services" as a priority (p. 49). Specifically, Strategic Direction 2 (SD2) aims to "Protect and Improve Universal Health Coverage (UHC)" and ensure "no one is left behind" (p. 49). Key interventions under SD2, such as "Implement the Continuity of Essential Health Services (CEHS) plan" and "Define essential health services; ensure their continuity" (p. 54), imply an intention to maintain access to necessary services, which would inherently require equitable distribution of resources. However, the NHSP document does not detail specific mechanisms or a concrete plan for ensuring equitable distribution of stockpiled medical supplies during an emergency. The emphasis is on improving access to services and ensuring continuity of care rather than specific logistics for distributing emergency medical commodities. ⁴⁰⁷

No relevant evidence was found on the website of the Ministry of Health. ⁴⁰⁸

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

Score: 0

There is no conclusive evidence that Seychelles maintains a dedicated, formal stockpile of laboratory supplies (e.g., reagents, media) for national use during a public health emergency. Instead, existing evidence highlights significant gaps in the procurement and stockpiling of these resources.

The Joint External Evaluation (JEE) report from 2018 explicitly states, regarding laboratory testing, that "There is a need for a more effective system for procurement and stockpiling laboratory reagents and consumables to avoid stock outs" (p. 24). It also notes a "lack of essential reagents such as ATCC (American Type Culture Collection) for monitoring the quality of antimicrobial susceptibility testing" (p. 10). The JEE report mention that "a minimum stock of three months worth of drugs and consumables (such as doxycycline, cotrimoxazole, ciprofloxacin etc. for plague) is maintained at the Central Medical Stores (CMS)" as a "buffer stock for any epidemic". This refers primarily to essential medicines, but not other classes of medical supplies, such as personal protective equipment (PPE) (p. 42). ⁴⁰⁹

The National Health Strategic Plan (NHSP) 2022-2026 also lists "occasional stock-outs of certain medicines and supplies" and the "need for more effective in-country stock-management and distribution of medicines and supplies" as outstanding issues under commodities (p. 30, 74). The NHSP 2022-2026 acknowledges that global disruptions, such as those caused by the COVID-19 pandemic, "severely compromised the procurement of medicines and medical products" (p. 69), which would directly impact the availability of laboratory supplies. ⁴¹⁰

The Infection Prevention and Control (IPC) Strategic Framework 2021-2025 notes that in 2019, "the majority of HCWs interviewed… were not satisfied about the quality and frequent stockouts of basic supplies. The situation seems to be the same at the health care facility level where stockouts are still currently being experienced." It further identifies "Ensuring sufficient equipment and supplies to deliver the IPC recommendations" as a major challenge (p. 10, 12). ⁴¹¹

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

National reports indicate that a "national stockpile" of medical countermeasures (MCM) assets, in the broader strategic sense for public health emergencies, does not exist in Seychelles. Therefore, there is no evidence of an annual review of such a national stockpile.

The Joint External Evaluation (JEE) of IHR Core Capacities report from 2018 explicitly states: "No national stockpile of MCM assets exists, but a minimum stock of three months worth of drugs and consumables (such as doxycycline, cotrimoxazole, ciprofloxacin etc. for plague) is maintained at the Central Medical Stores (CMS)." (p. 42). This clarifies that while routine operational stock (e.g., a three-month supply of certain drugs and consumables) is maintained at the Central Medical Stores, it is not categorized as a dedicated national stockpile for public health emergencies in the sense of strategic reserves. The JEE report further highlights this as an area for improvement: "There is a need to develop a national plan and framework for medical countermeasures that addresses the most important public health risks that the country faces." (p. 43) Moreover, "There are no existing frameworks or MOUs with regional or international partners for stockpiling, maintaining and/or sharing MCM assets." (p. 43). ⁴¹²

The National Health Strategic Plan (NHSP) 2022-2026, under its "Invest for Results" strategic direction, does list "Maintain minimum stock of essential medicines, medical supplies and equipment" as a key intervention, with a milestone of "Annual report on stock levels and utilisation" (p. 82). However, this refers to the routine monitoring of general stock levels for operational purposes, not a strategic annual review of a national emergency stockpile, which the JEE previously stated does not exist. The NHSP does not indicate that this routine stock monitoring is specifically geared towards assessing sufficiency for a large-scale public health emergency that would require a dedicated national emergency stockpile. ⁴¹³

No relevant evidence was found on the websites of the Ministry of Health, the Ministry of Fisheries and Agriculture, or the National Institute of Health and Social Sciences. ^414415416

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

Score: 0

Seychelles does not meet any of the three criteria.

There is insufficient evidence of a plan or agreement to leverage domestic (public or private) or regional manufacturing capacity to produce medical supplies for national use during a public health emergency. The National Health Strategic Plan 2022-2026 notes Seychelles' "narrow resource base and local manufacturing capacity" in a general economic context (p. 12), implying limitations in domestic production across sectors, including potentially for medical supplies. The discussions around acquiring medical supplies consistently focus on procurement through international channels rather than local or regional manufacturing. ⁴¹⁷

There is also no clear evidence of a plan or mechanism to procure medical supplies for national use during a public health emergency. The Joint External Evaluation (JEE) of IHR Core Capacities (2018) mentions some agreements with suppliers for emergencies (p. 34-35), and it notes that Seychelles has established credit lines with international MCM manufacturers (p. 43). While these references support the existence of general procurement processes, they stop short of outlining formal plans or mechanisms for specifically addressing emergency procurement needs. Furthermore, the JEE report acknowledges that Seychelles lacks a strategic national stockpile of medical countermeasures (MCMs), which limits its preparedness for emergencies. Reliance on ad hoc international procurement during crises does not constitute evidence of a defined plan or mechanism tailored for emergency situations. ⁴¹⁸

Finally, while there are fragmented references to expedited processes, there is insufficient evidence of a plan or mechanism to expedite medical supplies through points of entry during public health emergencies. The JEE report mentions that the Pharmacy Act (1990) is being reviewed to include "regulations relating to emergency approvals for medications, reagents and consumables during public health emergencies" (p. 42). However, this revision was a work in progress at the time of the JEE report, and there is no confirmation of its finalization or implementation. Furthermore, the JEE mentions coordination at points of entry among public health authorities, law enforcement, and port/airport control during outbreaks (p. 8), but these linkages focus on health event management rather than the expedited movement of medical supplies. Similarly, provisions in the National Integrated Emergency Management Plan (NIEMP) for engaging the high-level "Platinum Group" during Level 4 emergencies (p. 34) include the potential for requesting international assistance but do not describe specific mechanisms for expediting the entry of medical supplies. ⁴¹⁹⁴²⁰

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

Score: 100

Seychelles meets two of these criteria.

There is no direct evidence in the provided documents of a specific plan or agreement to leverage domestic (public or private) manufacturing capacity for laboratory supplies like reagents or media during a public health emergency. The National Health Strategic Plan 2022-2026 (NHSP) mentions that Seychelles has a "narrow resource base and local manufacturing capacity" for general consumption (p. 12), indicating a general limitation in domestic production. ⁴²¹

There is evidence of a general plan and mechanism for the procurement of emergency supplies, which would encompass laboratory supplies. The Joint External Evaluation (JEE) of IHR Core Capacities report from 2018 notes that "Seychelles has signed agreements with suppliers in case of emergency." (p. 34-35) and that "The country has well established credit lines with MCM manufacturers all over the world." (p. 43). ⁴²² This indicates that financial and contractual mechanisms are in place to acquire supplies, including medical countermeasures (MCMs), which often involve laboratory-related items during a public health emergency. Moreover, the NHSP 2022-2026 recognizes that "Restrictions in international air travel… severely compromised the procurement of medicines and medical products" during the COVID-19 pandemic (p. 70). ⁴²³ The IPC Strategic Framework 2021-2025 also points to improvements in the "procurement, stores and supplies management system" (p. 10-11) and calls for ensuring the availability of IPC equipment and logistics (p. 23), which includes laboratory-related items. ⁴²⁴

There is evidence of a plan to create and formalize mechanisms to expedite critical medical and laboratory supplies through points of entry during a public health emergency. The JEE explicitly states: "In line with African Union recommendations, the Pharmacy Act (1990) is being reviewed to include regulations relating to emergency approvals for medications, reagents and consumables during public health emergencies." (p. 42). The JEE also indicates coordination: "The Public Health Authority, law enforcement, port/airport control and customs are linked during unusual health events or suspected outbreaks" (p. 8). ⁴²⁵ For Level 4 national emergencies, the National Integrated Emergency Management Plan (NIEMP) outlines that a "Platinum group" of Ministers may be convened to manage high-level policy decisions, including "requests for international assistance" (p. 34). ⁴²⁶

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Seychelles does not meet any of the four criteria.

There is no documented evidence of a coordinated system specifically designed for health emergency logistics that integrates procurement, storage, and distribution of medical supplies at both national and subnational levels. The National Health Strategic Plan (NHSP) 2022-2026 mentions the existence of a Central Medical Stores (CMS) and procurement units for routine supply chain management, but it does not describe any national mechanism tailored for emergencies (p. 74-76). ⁴²⁷ The Joint External Evaluation (JEE) 2018 confirms that Seychelles depends heavily on reactive procurement and external suppliers for health emergencies, indicating the absence of a proactive and fully integrated logistics system (p. 42). ⁴²⁸ TWhile the National Integrated Emergency Management Plan (NIEMP) mentions “logistics resource management” under general disaster response (NIEMP, p. 51), it does not explicitly cover a dedicated mechanism for the coordination of health-specific supplies (e.g., medical countermeasures, vaccines, PPE) for emergencies. ⁴²⁹

There is no publicly available evidence indicating that an emergency logistics system for health is regularly exercised, reviewed, or updated. While the NIEMP emphasizes the need for general disaster-response exercises and after-action reviews to identify gaps and refine processes, there is no mention of a specific health supply chain system being evaluated through these mechanisms (p. 39). ⁴³⁰ Similarly, the NHSP 2022-2026 focuses on strengthening routine health logistics, including stock management and procurement capacity, but does not describe a mechanism for ongoing testing or updating of a health-specific emergency supply chain (p. 75). ⁴³¹

Seychelles demonstrates effective cold chain management for routine immunization programs, as noted in the JEE 2018, which states that “cold chain management and temperature monitoring are very effective at national and sub-national levels” (p. 21-22). However, there is no evidence that these capabilities are integrated into a broader emergency logistics system for the rapid deployment of health supplies during public health crises. Although cold chain procedures are well-established for vaccines under routine conditions, the lack of documentation relating to their use in emergencies highlights a critical gap in emergency logistics planning. ⁴³²

Although Seychelles’ plans include references to private-sector and NGO involvement in emergency management, there is no formal mechanism ensuring the integration of their logistics capabilities into a unified health emergency supply chain. The NIEMP includes coordination with NGOs, private sector actors, and civil society as part of its disaster response framework (p. ix, 51), but this is general in nature and does not specifically address health emergency logistics. ⁴³³ Meanwhile, the NHSP 2022-2026 acknowledges weak communication and regulatory frameworks between the Ministry of Health (MoH) and private providers, as well as limited private-sector reporting (p. 31, 53). ⁴³⁴ This reinforces the lack of a fully integrated supply chain mechanism for health emergencies that leverages private-sector capabilities.

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

Score: 0

Seychelles currently lacks a comprehensive national framework or overarching plan specifically dedicated to the dispensing of medical countermeasures (MCM) for national use during a public health emergency, which would include antibiotics, vaccines, therapeutics, and diagnostics. This is noted in the Joint External Evaluation of International Health Regulations (IHR) core capacities, stating that "There is no national framework for Medical countermeasures (MCM) and personnel deployment, though contingency plans are in place for Ebola and plague, following recent preparedness planning in response to these threats." (p 41). ⁴³⁵

Despite this, there are existing elements and ongoing efforts that contribute to MCM management. The country primarily relies on its current essential medicines list for procuring medical supplies, which covers prevalent conditions and diseases identified by the Ministry of Health. A minimum three-month stock of certain drugs and consumables, such as doxycycline, cotrimoxazole, and ciprofloxacin, is maintained at the Central Medical Stores (CMS) to serve as a buffer for potential epidemics (p. 42). ⁴³⁶

The need to establish a dedicated national MCM framework is recognized, as highlighted by a recommendation in the JEE Seychelles document to "develop a national plan and framework for medical countermeasures that addresses the most important public health risks that the country faces." (p. 42). Furthermore, the Pharmacy Act (1990) is undergoing review to incorporate regulations for emergency approvals of medications, reagents, and consumables during public health emergencies (p. 42). Despite the JEE being from 2018, no completed review of the Pharmacy Act was found available online. ⁴³⁷

Complementing these efforts, the National Health Strategic Plan 2022-2026 outlines an intention to "develop an Essential List of Health Products, that similar to the Essential List of Medicines, aligned with the agreed package of care and services." This plan also aims to "introduce mechanisms for the introduction of new health products and technologies and revise the procurement process to avoid stock-outs" (p. 74). ⁴³⁸ Additionally, the Infection Prevention and Control Strategic Framework 2021-2025 emphasizes the importance of standardizing and ensuring the availability of materials and equipment for infection prevention and control in health facilities, which includes collaborating with procurement and central stores to improve stock management practices (p. 23). ⁴³⁹

No relevant evidence was found on the website of the Ministry of Health. ⁴⁴⁰

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

Score: 100

Seychelles does have provisions and capabilities in place to facilitate workforce surge during an emergency, primarily through legal frameworks and observed past actions.

According to the Joint External Evaluation (JEE), the Public Health Act of 2015 grants the Public Health Authority the ability to "commandeering any facility should additional beds be required" and states that "Staff can be repurposed easily to provide surge capacity" (p. 34). Furthermore, the JEE recommended the development of a "public health workforce strategy that addresses identified gaps in existing human resources in the human, animal and environmental health sectors, and which emphasizes cross disciplinary working by a multi-skilled public health workforce" (p. 33). It also suggested implementing "innovative mechanisms for providing incentives and improving retention of public health staff" and developing a "national framework for medical countermeasures and personnel deployment" (p. 33, 42). ⁴⁴¹

The National Health Strategic Plan (NHSP) 2022-2026 notes that, during the COVID-19 pandemic, healthcare workers (HCWs) were indeed "redeployed to new isolation and treatment facilities" to meet increased demands, highlighting the system's ability to reallocate personnel in a crisis (p. 69). This operational response, while effective in addressing immediate needs, also brought to light that HCWs were sometimes "redeployed to areas in need, in some instances with little or no training and little consideration of effects on their mental health and wellbeing" (p. 70). This suggests that while redeployment occurs, a formalized and extensively planned public strategy specifically for workforce surge, including comprehensive training and welfare considerations, is an area for further development. ⁴⁴²

The country recognizes the importance of a robust workforce for health security. The NHSP emphasizes the need for an "adequate resilient workforce" and commits to developing a "national Human Resources for Health Strategy to guide the production, recruitment, deployment, retention and remuneration of health care workers" (p. 77). This strategy aims to ensure that "HR planning, administration and management [are] fit-for-purpose" and includes key interventions such as making recruitment clear and transparent, providing mentorship and supportive supervision, and making health careers more attractive (p. 78). ⁴⁴³

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

Seychelles currently does not possess a comprehensive public plan or national framework specifically designed for receiving health personnel from other countries to respond to a public health emergency.

The Joint External Evaluation (JEE) of IHR core capacities explicitly notes that "There is no national framework for Medical countermeasures (MCM) and personnel deployment" (p. 41). Despite this identified gap, the country has existing provisions and experiences related to foreign health workers. Seychelles' health system heavily relies on expatriate staff, with 60% of its doctors being foreign nationals who received their training abroad (p. 42). There are "provisions in place for emergency registration of health professionals from other countries who may come in to assist Seychelles as required" (p. 43). Additionally, the country maintains "a relatively quick and streamlined process for routine registration of health personnel" (p. 43). These elements suggest some foundational capacity for integrating foreign health workers, albeit not within a dedicated emergency-specific plan for international surge. ⁴⁴⁴

The JEE report highlights areas needing strengthening, indicating that "the regulatory councils’ protocols for registering health professionals need to be updated to outline clearly the particular issues of receiving personnel during PHEIC" (p. 42). To address this, a key recommendation is to "Develop a personnel deployment framework or plan that outlines the minimum standards for receipt (and deployment) of personnel during public health emergencies" (p. 42). ⁴⁴⁵

Furthermore, the National Integrated Emergency Management Plan (NIEMP) outlines a broader system for coordinating international cooperation during emergencies. It describes a process for requesting international assistance and registering aid offers through the National Emergency Operations Centre's Humanitarian Assistance Module (p. 51). This general framework for international aid could potentially be leveraged for health personnel, but it is not a specific plan for medical workforce surge from abroad. ⁴⁴⁶

The Center for Excellence in Disaster Management & Humanitarian Assistance (CFE-DM) Handbook also mentions that the Ministry of Foreign Affairs coordinates international assistance upon request from the Disaster Risk Management Division (p. 43). ⁴⁴⁷

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

Seychelles does have mechanisms and practices in place for redeploying existing health personnel within the country, both geographically and by role, particularly during public health emergencies, although a detailed, publicly accessible, overarching plan outlining the specific procedures for such redeployment across all scenarios is not readily available.

According to the Joint External Evaluation, the Public Health Act of 2015 provides the legal basis for such actions, enabling the Public Health Authority to repurpose staff readily to increase surge capacity in emergency situations. This means that existing health personnel can be assigned to different roles or locations as needed to address the demands of a crisis (p. 34). ⁴⁴⁸

The National Health Strategic Plan (NHSP) 2022-2026 notes that, during the COVID-19 pandemic, for instance, there was active redeployment of healthcare workers (HCWs). Many HCWs "were redeployed, and many services were (temporarily) interrupted" to support the response (p. 32). This redeployment extended to staff being moved "to new isolation and treatment facilities," demonstrating both geographical and role changes to meet the urgent needs of the pandemic (p. 69). However, this rapid redeployment also highlighted challenges, as some HCWs were moved "to areas in need, in some instances with little or no training and little consideration of effects on their mental health and wellbeing," indicating that while redeployment is feasible, comprehensive pre-planning for training and support during such shifts could be enhanced (p. 70). ⁴⁴⁹

Looking forward, the NHSP 2022-2026 acknowledges the importance of "deployment" within its broader human resources strategy. It commits to developing a "national Human Resources for Health Strategy to guide the production, recruitment, deployment, retention and remuneration of health care workers" (p. 77). This indicates an intent to formalize and guide future deployment practices more comprehensively, addressing the current reliance on ad hoc or reactive measures. ⁴⁵⁰

Further reinforcing the commitment to optimize workforce management, a new Human Resources for Health (HRH) plan is currently being developed by the Ministry of Health (MoH) in collaboration with the World Health Organization (WHO). This plan aims to establish a clearer framework for HR management, explicitly including "redeploying staff where needed" as one of its key objectives. The goal is to ensure the existing workforce is optimized and staff are "working where they are most needed" to create a more sustainable and efficient health system. This comprehensive HRH plan was anticipated to be finalized by the end of 2024, however, no plan was found available online. ⁴⁵¹

No relevant evidence was found on the website of the Ministry of Health. ⁴⁵²

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 100

The constitution of Seychelles explicitly guarantees citizens' right to medical care, including a guarantee for free primary health care.

According to Article 29 of the Constitution, "The State recognises the right of every citizen to protection of health and to the enjoyment of the highest attainable standard of physical and mental health". To ensure the effective exercise of this right, the State undertakes "to take steps to provide for free primary health care in State institutions for all its citizens". ⁴⁵³

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

Score: 100

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

Score: 44.82

4.4.1d Coverage of essential health services through universal health coverage

Score: 100

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: 74.76

4.4.1f Rate of mortality amenable to health care

Score: 10.48

4.4.2a Guaranteed paid sick leave

Score: 100

Workers in Seychelles are guaranteed paid sick leave, and this leave is available for conditions that render a worker "unfit for work," which includes both physical and mental health problems, provided a medical certificate is produced.

According to the 1991 Employment (Conditions of Employment) Regulations, a worker, other than a casual or part-time worker, is entitled to an aggregate maximum of 21 days’ paid sick leave within any 12-month period. If a worker is required by a medical practitioner to be confined to a hospital or similar institution, or at home for a continuous period extending beyond the unexhausted part of the 21 days, they are entitled to a further maximum of 30 days’ paid sick leave (Section 12(1)(a) and (b)). Part-time workers are also entitled to paid sick leave, proportionate to the number of days they work per week (Section 14). ⁴⁵⁴

Entitlement to sick leave arises when "a medical certificate of unfitness for work or confinement, as the case may be, is produced" (Section 12(2)(a)). A "medical certificate" is defined as a certificate issued by "a medical practitioner, or other person authorized by the Minister responsible for Health to issue certificates for the purposes of these Regulations" (Section 2). The regulations do not specify or limit "unfitness for work" to only physical ailments. In general legal and medical contexts, a "medical practitioner" can certify unfitness for work due to both physical and mental health conditions. Therefore, provided a qualified medical practitioner issues a certificate stating that a worker is unfit to perform their duties due to a mental health problem, the sick leave provisions would apply. ⁴⁵⁵

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no explicit legislation, policy, or public statement found that commits to providing prioritized healthcare services specifically to healthcare workers (HCWs) who become sick as a direct result of responding to a public health emergency.

National documents indicate a recognition of the importance of HCW safety, well-being, and capacity building during emergencies. The National Health Strategic Plan 2022-2026, under "SD5 Invest for Results," identifies "Care for the carers" as a priority area. This includes interventions to make "health and safety a priority for HCWs" and the development of "Tailored cadre and age-specific HCW screening programmes." Additionally, it aims to "Address mental wellbeing" by establishing "Support groups and programmes for at-risk HCWs" (p. 79). The plan acknowledges the "considerable pressure" and "strain" on HCWs due to public health emergencies, noting that many were redeployed during the COVID-19 pandemic (p. 69, 70, 99). ⁴⁵⁶

The Infection Prevention and Control 5-Year Strategic Framework 2021-2025 emphasizes the Ministry of Health's responsibility for "provision of a safe working environment for patients, staff and visitors" (p. 20). It includes a strategic objective to "Ensure surveillance of occupational associated infections among health care workers" with key activities to "Develop and/ or review and promote use of guidelines on management of work-related infections" and "Promote the screening and immunization of HCWs" (p. 20-21). The framework also lists "Staff health and safety" indicators for monitoring "prioritized health care workers infections" and "follow-up exposed/infected HCWs with COVID-19," which suggests managing their health condition but does not explicitly guarantee prioritized access to healthcare services over other patients in an emergency context (p. 42-43). ⁴⁵⁷

Furthermore, efforts are made to build HCW capacity and safety through training, such as the contact tracing training facilitated by WHO for health professionals and volunteers in response to a plague outbreak in 2017. This training aimed to equip HCWs and volunteers with essential skills for emergency response, thereby contributing to their overall safety and preparedness during public health crises. ⁴⁵⁸

No relevant evidence was found on the website of the Ministry of Health. ⁴⁵⁹

While these efforts demonstrate a commitment to HCW occupational health, safety, prevention, and follow-up for work-related illnesses, and training to equip them for emergency response, they do not explicitly detail a policy or plan for prioritized healthcare services for HCWs who fall sick due to emergency response efforts.

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

Score: 100

Seychelles has several systems and mechanisms in place to facilitate communication between public health officials and healthcare workers during a public health emergency. These include formal coordination structures, electronic systems, and modern digital communication tools.

A core aspect of this communication infrastructure is the commitment to establishing and maintaining effective coordination and communication systems. The National Health Strategic Plan (NHSP) 2022-2026 outlines the strategic directive to "Implement effective coordination and communication systems" (p. 43). This involves developing formal mechanisms to facilitate communication within the Ministry of Health (MoH) and its entities, as well as with external stakeholders, utilizing tools such as circulars, information bulletins, leadership blogs, forums, committees, and platforms. The plan aims to ensure that decisions from the senior executive committee are disseminated to all healthcare workers, including those in the private sector, when necessary (p. 44). Effective communication strategies are also developed and implemented to support this goal (p. 44). ⁴⁶⁰

During the COVID-19 pandemic, the health system demonstrated adaptability by significantly increasing its use of modern communication technologies. This shift included the widespread adoption of "instant messaging platforms for sharing information and coordinating work, electronic platforms for data management around testing and surveillance, video conferencing systems for meetings, social media platforms and e-mails for risk communication" (p. 32). These tools became vital for real-time information exchange and coordination during the emergency. ⁴⁶¹

According to the Joint External Evaluation (JEE), the Integrated Disease Surveillance and Response (IDSR) Committee plays a crucial role as a multi-sectoral and multidisciplinary coordination mechanism. Located within the Public Health Authority (PHA), the national IHR focal point (NFP) is part of this committee, which meets regularly to coordinate IHR implementation and facilitate information exchange. This includes regular communication between the Veterinary Department, the Epidemiology Department, and laboratories regarding zoonotic risks or events (p. 7). The Public Health Authority maintains links with law enforcement, port/airport control, and customs during unusual health events or suspected outbreaks (p. 8). ⁴⁶²

Electronic systems form a significant part of the communication network. A web-based e-surveillance system is operational, connecting 57 reporting sites across the country, including both government and private health facilities. All facilities are connected to an intranet system, enabling the issuance of email alerts to relevant stakeholders for priority notifiable diseases. Laboratory services are directly integrated with this surveillance system (p. 27). This e-surveillance system is capable of generating alerts for epidemic-prone diseases and unusual health events, such as influenza-like illness and dengue-like illness (p. 26). ⁴⁶³ Morevoer, as described in the Disaster Management & Climate Change Handbook for Seychelles, the national telecommunications infrastructure is highly efficient, with widespread cellular telephone use, facilitating mobile communication (p. 24). ⁴⁶⁴

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

Score: 100

The system for communication between public health officials and healthcare workers during an emergency is designed to encompass both the public and private sectors, though challenges in its full and effective implementation are acknowledged.

The National Health Strategic Plan (NHSP) 2022-2026 explicitly aims for senior executive committee decisions to "reach all health care workers in MoH (and the private sector when needed)" (p. 44). This plan also lists "Improve collaboration with private health sector and health-related NGOs" as a specific objective (p. 39). Furthermore, annual coordination meetings are conducted "with the private health sector and civil society" to foster communication and collaboration (p. 44). ⁴⁶⁵

In terms of data and reporting, the Joint External Evaluation (JEE) report states that the web-based e-surveillance system, which is crucial for communication during emergencies, "has since been expanded to cover 57 reporting sites country-wide, including government and private facilities" (p. 26). This clearly indicates that private facilities are part of the electronic reporting network used by public health officials. However, the JEE also notes that "private facilities need to improve the overall timeliness of their reporting into the system" and that "inadequate reporting rates in private facilities should be addressed" (p. 26, 27). ⁴⁶⁶ This highlights a gap in the consistent functioning of this integrated system. The NHSP further points out that "Communication between MoH and the private sector is still poor; private-sector regulatory frameworks are weak, with inadequate reporting" (p. 31). ⁴⁶⁷

The Infection Prevention and Control (IPC) 5-Year Strategic Framework 2021-2025 also underscores the inclusion of the private sector in IPC efforts. It mentions that "IPC implementation has been extended to private health care facilities" (p. 7). Objectives within this framework include ensuring "IPC focal person nominated and functioning at all (100%) health care facilities (public and private)" and "100% availability of national IPC guidelines in all health care facilities (public and private)" (p. 13). ⁴⁶⁸

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

Score: 0

The country does not systematically monitor and track the number of healthcare-associated infections (HCAIs) that occur in healthcare facilities.

The Annual Health Sector Performance Report 2023 explicitly states: "Data on hospital acquired infections were not being systematically collected since 2014, plans were underway in 2023 to build capacity of the IPC Committee and IPC focal persons to produce this information in the future." (p. 62). ⁴⁶⁹

The Infection Prevention and Control 5-YEAR Strategic Framework 2021-2025 provides further detail on the current situation regarding HCAI surveillance: "Overall, systems for HAIs surveillance are not systematically implemented in the country. HAIs surveillance is ad hoc (only done when there is a report of an outbreak) and fragmented with very little or no communication of data for action. The 2019 evaluation noted an overall score of 38%. There is a system for laboratory-based surveillance of hospitalized patients where all specimens with positive result of a multi-drug resistant organism is communicated to the IPC unit, but this is also not functioning well." (p. 9). ⁴⁷⁰

While the IPC Strategic Framework outlines future objectives and activities to "Strengthen system for surveillance of selected healthcare associated infections, including outbreaks and AMR" (p. 20), these are planned interventions to address a current deficiency, rather than evidence of an existing systematic monitoring program. Expected key achievements by 2025 include "Surgical Site Infection (SSI) surveillance reporting in all (100%) hospitals performing surgery and evidence of response measures initiated" (p. 13), clearly indicating this is a future goal. ⁴⁷¹

The 2023 Annual Hospital Services Statistical Report and the Primary Health Care Annual Statistical Report 2023 provide extensive statistics on hospital services and primary care activities, respectively, but neither report includes any specific data or indicators related to the incidence or tracking of HCAIs. This absence further supports the statement that such data are not systematically collected. ⁴⁷²⁴⁷³

4.6.1b Infection prevention and control programme

Score: 100

There is clear evidence of an infection prevention and control (IPC) program in place nationally in Seychelles, with ongoing efforts to strengthen and institutionalize it further.

Seychelles has a "National Infection Prevention and Control Strategic Framework 2021-2025" which explicitly states its purpose is to guide the implementation of evidence-based IPC standards over this period. This framework builds upon findings from an evaluation of a prior "2014-2018 IPC strategic plan," indicating a continuous and evolving national effort in this area (p. 1, 5). The goal of this strategic framework is "to position the prevention and control of infectious diseases as an important tactical area of focus in the mainstreaming of health care quality and service improvement" (p. 12). ⁴⁷⁴

A national IPC program has been established since 2010, as highlighted in the Joint External Evaluation (JEE) report from 2018. This report gave Seychelles' "Healthcare associated infection prevention and control programmes" a score of 5 (the highest score), noting that the program is "well-developed," "managed at national level by a dedicated IPC nurse," and includes "written policies and guidelines" along with monitoring tools (p. 11). The program also features a "multidisciplinary IPC committee that draws up an annual action plan and holds scheduled meetings" and a network of focal persons in health facilities (p. 11). ⁴⁷⁵

While a program is undeniably in place, the more recent 2021-2025 strategic framework acknowledges areas for further development, stating that "Seychelles is yet to put in place a standalone IPC programme" in alignment with specific WHO recommendations (p. 7). This indicates a focus on refining its structural and organizational arrangements, particularly at the leadership and management levels, and ensuring sustained financial and resource allocation (p. 14-16). The framework also outlines strategic objectives for improving IPC guidance documents, educating and training healthcare workers and the public, strengthening surveillance for healthcare-associated infections (HAIs) and antimicrobial resistance (AMR), enhancing supportive supervision and evaluation, and optimizing the built environment and availability of materials (p. 14-23). ⁴⁷⁶

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

Score: 100

There is evidence of a comprehensive plan and ongoing efforts to ensure a safe environment in health facilities nationally in Seychelles. This is addressed through strategic planning documents that focus on infrastructure, maintenance, and the integration of safety principles.

The National Health Strategic Plan (NHSP) 2022-2026 specifically outlines a commitment to improving health infrastructure as a critical input for effective healthcare delivery. Under Strategic Direction 5, "Invest for Results," the plan states: "The health sector will elaborate a comprehensive infrastructure development and management plan to address resilience in the face of climate change, disability access to facilities, fire and other risks, and address the challenges of inadequate safe and secure storage for supplies. The plans will ensure that new buildings are more fit-for-purpose, and outdated facilities are gradually brought up to standard." (p. 76). ⁴⁷⁷

This overarching plan is further detailed with specific objectives and key interventions. "5.4.1 Build for purpose" includes developing an "Infrastructure Masterplan based on actual and anticipated needs" and to "Develop and implement local accreditation standards for health infrastructure." (p. 83). "5.4.2 Make infrastructure resilient, safe and accessible for all" outlines actions such as: Conducting an "inventory of infrastructure and create a facilities master-list"; Drawing up an "infrastructure and equipment maintenance plan"; Assessing "infrastructure for fire, flooding, chemical, radiological and biological risks" and ensuring "All facilities have a fire evacuation plan in place" and "Regular fire drills conducted"; and Ensuring "facilities are disabled friendly" by establishing "minimum standards for disability access." (p. 83). These initiatives directly respond to issues identified in the situation analysis of the NHSP, which noted that "Many safety risks remain chronically unaddressed – fire, flood, storm, chemical, biological and radiological" and that "Preventive maintenance systems are weak, and repairs/replacements often much delayed" (p. 30). ⁴⁷⁸

Furthermore, the Infection Prevention and Control 5-Year Strategic Framework 2021-2025 also addresses environmental safety within health facilities, particularly from an IPC perspective. One of its strategic objectives is to "Strengthen system to enhance built environment, including Water Sanitation and Hygiene (WASH)" (p. 15). Key activities under this objective include: "Work with PIU (Project Implementation Unit) and CIC (Capital Infrastructure Committee) to ensure incorporation of IPC recommendations in planning, provision of and maintenance of buildings and fixtures"; Advocating "for provision of domestic and sluice rooms for housekeeping activities"; and Fostering "closer collaboration between the PIU, CIC and IPCC on design and renovation of health care facilities" (p. 37). The document explicitly states that "Patient care activities delivered in a clean and hygienic environment with appropriate Water Sanitation and Hygiene (WASH) facilities is critical to both patients and HWCs, as it promotes practices that prevent and control HAIs and AMR" (p. 10). ⁴⁷⁹

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is evidence that a national requirement for ethical review exists before beginning a clinical trial or any research project in Seychelles.

The Joint External Evaluation (JEE) of IHR Core Capacities report from 2018 explicitly states: "The MOH Research and Ethics Committee approves all research projects, including their biosafety and biosecurity aspects." (p. 19). Clinical trials are a specific type of research project, and thus would fall under this requirement.

Further evidence from the National Health Strategic Plan (NHSP) 2022-2026 reinforces the existence and importance of this body: Under the section "SD6 Improve Data for Impact," one of the specific objectives is "6.6 Strengthen research capacity." The key interventions to achieve this include: "Strengthen Ethics Committee" and "Develop a policy to guide research in MoH" (p. 88). The objective to "Strengthen Ethics Committee" confirms its active role and implies an ongoing commitment to its function in overseeing research. The development of a "policy to guide research in MoH" would further formalize and detail the processes for ethical review, including for clinical trials. ⁴⁸⁰

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

Score: 0

There is no publicly available evidence of an established expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results from trials taking place elsewhere to treat ongoing pandemics or epidemics in Seychelles.

The national documents consistently indicate that the foundational legislative and regulatory frameworks for health technologies and emergency approvals for medical products were still under development or review during the periods covered. Specifically, the Joint External Evaluation (JEE) report from March 2018 noted that Seychelles had "no national framework for Medical countermeasures (MCM) and personnel deployment" (p. 42). It further recommended as a priority action to "Develop a medical countermeasures deployment plan" (p. 43). Crucially, the JEE report also mentioned that "the Pharmacy Act (1990) is being reviewed to include regulations relating to emergency approvals for medications, reagents and consumables during public health emergencies" (p. 42). ⁴⁸¹

Moving to the National Health Strategic Plan (NHSP) 2022-2026, the section on "Outstanding issues in Health Technologies" directly states a "Lack of regulatory framework for health technologies" (p. 74). To address this, the NHSP outlines a specific objective under "Invest for Results" (SD5) to "Create a legislative framework for the regulation of health technologies" and aims to "Finalise Medical Products and Pharmacy Operations Bill," with the milestone being its enactment and implementation (p. 78). ⁴⁸²

Further supporting this, the Annual Health Sector Performance Report for 2023, in its "Regulatory Unit" section, states that "The regulatory frameworks for health services were in a state of evolution in 2023. New regulations for medical products and pharmacy operations were under development" (p. 39). This confirms that as late as 2023, the necessary regulations were still being formulated and were not yet established. ⁴⁸³

Other national documents, the Infection Prevention and Control Strategic Framework 2021-2025 and Seychelles National Integrated Emergency Management Plan, focus on infection prevention and control practices and general emergency management respectively, and do not contain information related to the approval of medical countermeasures, clinical trials, or mutual recognition processes. ⁴⁸⁴⁴⁸⁵

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 0

There is a government agency with a broad regulatory mandate in the health sector, the Public Health Authority (PHA), but the specific legislative framework for approving new medical countermeasures (MCM) for humans is still under development.

According to the Annual Health Sector Performance Report 2023 (p. 13) and the National Health Strategic Plan 2022-2026 (p. 29), the Ministry of Health (MoH) restructured its system to separate service delivery from regulatory functions, with the Public Health Authority (PHA) being established as the primary regulatory body responsible for protecting the nation's health under the Public Health Authority Act 2013. ⁴⁸⁶⁴⁸⁷ The PHA is tasked with developing the necessary legislation, tools, and processes for regulating the health sector (p. 57). ⁴⁸⁸

However, reports indicate that a comprehensive framework specifically for MCM approval was not yet fully operational. The National Health Strategic Plan 2022-2026 explicitly notes a "Lack of regulatory framework for health technologies" as an outstanding issue and sets an objective to "Create a legislative framework for the regulation of health technologies" through the finalization and implementation of a "Medical Products and Pharmacy Operations Bill" (p. 74, 78). ⁴⁸⁹ This bill was still "under development" as of 2023 (p. 39). ⁴⁹⁰ The JEE report from March 2018 also noted the absence of a "national framework for Medical countermeasures" and that the "Pharmacy Act (1990) is being reviewed to include regulations relating to emergency approvals for medications, reagents and consumables" (p. 42). ⁴⁹¹

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

Seychelles has an established and expedited process for approving medical countermeasures (MCM) for human use or recognizing approval decisions made elsewhere during public health emergencies. This process is formalized through the Public Health (Emergency Use Authorisation of Vaccines and Medical Products) Regulations, 2021, issued on 24th February 2021 as S.I. 14 of 2021 under the Public Health Act.

These regulations establish a clear legal framework for the emergency use authorization (EUA) of vaccines and medical products in Seychelles during a public health crisis. The Minister responsible for Health is empowered to authorize the use of these products specifically for emergency situations involving treatment, prevention, control, or suppression of diseases during a public health emergency. This authorization is granted upon the recommendation of the Public Health Commissioner, ensuring a scientific and public health basis for such decisions. Any authorization must clearly specify the details of the vaccine or medical product and the infectious disease it targets, and it must be issued in a specific form outlined in Schedule 1 of the regulations. Crucially, the Public Health Commissioner's recommendation is contingent upon ensuring that the vaccine or medical product does not cause any serious or life-threatening disease or condition, indicating a built-in safety consideration within the expedited process. ⁴⁹²

The Joint External Evaluation (JEE) report from 2018 had identified a gap in a national framework for Medical Countermeasures (MCM) and noted that the Pharmacy Act (1990) was under review to include regulations for emergency approvals (p. 42). ⁴⁹³ The National Health Strategic Plan (NHSP) 2022-2026 also highlighted the need for a legislative framework for health technologies and aimed to finalize the Medical Products and Pharmacy Operations Bill (p. 74, 78). ⁴⁹⁴ The Annual Health Sector Performance Report 2023 further confirmed that regulatory frameworks for health services, including those for medical products, were in a state of evolution and under development (p. 39). ⁴⁹⁵

The enactment of the Public Health (Emergency Use Authorisation of Vaccines and Medical Products) Regulations, 2021, specifically addresses the need for an expedited process, providing the legal and operational mechanism to swiftly introduce critical health interventions during emergencies.

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

Score: 100

Seychelles has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁴⁹⁶

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

Score: 0

Seychelles does not have a standalone national disaster risk reduction strategy specifically for epidemics and pandemics. While health emergencies are referenced in the National Health Strategic Plan (NHSP) 2022-2026, there are no detailed measures on how to reduce risks from pandemics or epidemics as distinct components of a comprehensive national risk reduction strategy.

The NHSP 2022-2026 outlines the health sector’s response to emergencies under its goal to “Prepare, prevent, detect early and respond to all health emergencies” (p. II, 36). It includes a Strategic Direction 3 (SD3) titled “Improve Health Security,” which addresses public health events, including emerging diseases such as COVID-19. This section also emphasizes a One Health approach, encouraging multi-sectoral collaboration across health, environment, and agriculture sectors (p. 55). While these provisions align with principles of broader risk reduction, they remain sector-specific and do not constitute an integrated, cross-sectoral framework for epidemic and pandemic risk reduction. Moreover, although the NHSP incorporates general resilience-building measures, such as climate change adaptation and health system strengthening (p. 49, 53), it lacks explicit details on identifying, mitigating, and reducing risks from pandemics and epidemics within a broader national disaster risk reduction framework. ⁴⁹⁷

The WHO Strategic Preparedness and Response Portal (SPH) notes that for a "NAPHS," the status for Seychelles is "No Data!". ⁴⁹⁸

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

Seychelles possesses cross-border agreements, protocols, and memorandums of understanding with neighboring countries and as part of a regional group concerning public health emergencies; however, there is evidence of gaps in their implementation.

The Joint External Evaluation (JEE) report from March 2018 states that Seychelles has a memorandum of understanding (MOU) with other Indian Ocean countries to guide preparation for and response to public health emergencies (p. 5). The report notes that this MOU facilitates collaboration and coordination (p. 5). However, a key area identified for strengthening was the recommendation to "Review the memorandum of understanding with other Indian Ocean countries to incorporate cross-border surveillance and response components in the context of the IHR (2005)" (p. 5). This suggests that while an MOU existed, it was not fully aligned with current International Health Regulations (IHR) requirements for surveillance and response, indicating a gap in its comprehensive implementation. The JEE also highlighted that while there is easy information exchange between the veterinary department, epidemiology department, and laboratories at a national level regarding zoonotic risks or events, "equivalent promptness is still required at local level" (p. 7), pointing to an implementation gap at sub-national levels. ⁴⁹⁹

Seychelles is a participant in regional initiatives like the Indian Ocean Commission's (IOC) Réseau SEGA One Health network, which connects animal and human health sectors across member states and supports regional epidemiological surveillance (p. 27). ⁵⁰⁰ This is confirmed by the Annual Health Sector Performance Report 2023, which notes Seychelles' continued use of the Réseau SEGA platform for collaboration on public health emergency information and epidemiologic surveillance (p. 15, 36). ⁵⁰¹ The network facilitates information sharing through IOC-organized teleconferences, enhancing coordination among member nations. These mechanisms reflect Seychelles’ regional engagement in multi-sectoral public health initiatives.

Despite these agreements and participation in regional networks, the JEE emphasizes significant implementation challenges. It pointed out that communication and coordination during emergencies—such as the Ebola epidemic in West Africa (2014-2016) and the Madagascar plague epidemic (2017)—were not always guided by formalized protocols or standard operating procedures (SOPs). The report outlined the need to establish formalized, sustainable communication processes to ensure consistent and effective responses in future events (p. 8). ⁵⁰² The National Health Strategic Plan (NHSP) 2022-2026 underscores similar concerns, mentioning that the future National Action Plan for Health Security (NAPHS) will focus on strengthening multi-sectoral collaboration, including the One Health approach, to address deficiencies in current frameworks (p. 56). ⁵⁰³

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Seychelles participates in regional mechanisms that include animal health aspects; however, there are identified gaps in the formalization and effectiveness of internal collaboration, which could impact the country's ability to fully implement these cross-border initiatives.

According to the Joint External Evaluation (JEE), the country engages in the Indian Ocean Community (IOC) through a One Health network, known as Reseau SEGA One Health, which connects animal and human health sectors across its member states (p. 15). This network implies cross-border collaboration on zoonotic risks and health issues that often originate in animal populations. ⁵⁰⁴ The Annual Health Sector Performance Report 2023 further mentions Seychelles' participation in the Réseau SEGA platform for regional epidemiologic surveillance (p.15, 36). ⁵⁰⁵ Additionally, Seychelles has a designated delegate for the World Organisation for Animal Health (OIE) who has undergone training on reporting procedures (p. 29), indicating adherence to international frameworks for animal health monitoring and reporting. The country also maintains a memorandum of understanding (MOU) with other Indian Ocean countries for broader public health emergencies, which could encompass zoonotic events originating from animal health (p. 5). ⁵⁰⁶

Despite these regional engagements, the JEE identified several gaps. It noted "weak collaboration among the various health sectors (human, animal and environment health)" domestically in the management of zoonotic diseases, stating that "There is no formalized and streamlined multi-sectoral collaboration for surveillance and response to zoonotic events" (p. 13). This internal lack of formalization significantly impacts the country's capability to effectively respond to animal health emergencies, including those with cross-border implications. The JEE specifically recommended the establishment of a national One Health coordination committee and the development of a national multisectoral surveillance plan for priority zoonotic diseases, including contingency plans for outbreaks (p. 14). This highlights that foundational national structures for coordinating animal health emergency responses were not yet robustly in place. Furthermore, the JEE indicated that "Zoonotic disease reporting is weak in both human and animal surveillance systems," with specific concerns for the animal health sector, and that "linkages and information exchanges between health sectors require improvement" (p. 15). The JEE also recommended that the existing MOU with Indian Ocean countries be reviewed "to incorporate cross-border surveillance and response components in the context of the IHR (2005)" (p. 5), suggesting a need for more explicit inclusion of animal health emergency aspects within existing cross-border agreements. ⁵⁰⁷

Finally, the National Health Strategic Plan 2022-2026 acknowledged the "urgent need to build strong partnerships with non-health sectors to prevent effectively detect, prevent and respond to zoonosis and food safety problems" (p. 55), reinforcing that strengthening the One Health approach at both national and regional levels remains an ongoing priority. ⁵⁰⁸

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Seychelles is fully a State Party to the Biological Weapons Convention (BWC) with the same legal effect as ratification. ⁵⁰⁹

Signing the BWC was only possible before its entry into force on March 26, 1975. Seychelles did not sign before that date (it was established as independent only in 1976). It therefore acceded (which has the same legal effect as ratification for states that didn't originally sign the treaty) on October 11, 1979. ⁵¹⁰

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

Score: 100

Seychelles submitted its first BWC CBM in 1994 and has submitted BWC CBMs on a regular basis since 2016. Latest CBM report was submitted in 2023. These are not publicly available. ⁵¹¹

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Seychelles submitted a national report to the 1540 Committee in 2008. ⁵¹²

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

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

Score: 0

Seychelles 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). ^513514515

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

Score: 0

Seychelles conducted a Joint External Evaluation (JEE) in 2018 and released a comprehensive report. No subsequent evaluations have been published since then. ⁵¹⁶

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

Score: 0

Seychelles has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years. ⁵¹⁷

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

Score: 0

Seychelles has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. ⁵¹⁸

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

Score: 0

There is no evidence that the country has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

The government consistently allocated a significant portion of its national budget to health during this period, earmarking 13% of the total budget for health in 2023, a level mirrored in the preceding two years (p.4, p.21). However, this represents a general health budget allocation. ⁵¹⁹

A key indicator of this investment is the improvement in the International Health Regulations (IHR) core capacities index, which rose from 53 in 2022 to 55 in 2023 (p.5, p.64). This improvement signifies national efforts and funding directed towards enhancing capabilities such as surveillance, laboratory systems, and emergency response, all crucial for addressing epidemic threats. Furthermore, the Ministry of Health hosted regional "training of trainers" workshops on Public Health Emergency Operations Centres (PHEOCs) in 2023, aimed at strengthening incident and PHEOC management (p.32), indicating an investment in workforce development for emergency response. ⁵²⁰

The National Health Strategic Plan (NHSP) 2022-2026, active throughout this period, explicitly includes "SD3 Improve Health Security" as a strategic direction (p.III, p.55). This strategic direction outlines objectives such as strengthening the "One Health approach," implementing IHR, and enhancing disease surveillance and response capabilities (p.55, p.58). The plan emphasizes building and maintaining IHR workforce capacity, and strengthening disease surveillance and response systems, all of which are funded through national allocations. ⁵²¹

The Expanded Programme on Immunisation (EPI), a critical component of pandemic and epidemic response, continued its operations and expanded its scope. This included the coordination of the COVID-19 vaccination campaign in 2023 and the introduction of new vaccines like the Hepatitis B birth dose (p.54, p.56, p.57), indicating ongoing national funding for these preventive measures. Additionally, the Seychelles Public Health Laboratory (SPHL) continued its work towards accreditation in 2023 (p.38), reflecting national investment in improving diagnostic capabilities essential for epidemic control. ⁵²²

A notable development relevant to financing health preparedness is the Seychelles' pioneering efforts in exploring innovative funding instruments, as highlighted by the IMF Article. The government has utilized the IMF’s Resilience and Sustainability Facility (RSF) to strengthen climate resilience and health security infrastructure. The funds provided through the IMF facility aim to improve Seychelles’ disaster preparedness and resilience, including climate-related health risks, but there are no explicit details in this IMF funding regarding its direct application to pandemic or epidemic threats. ⁵²³

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

Score: 0

National documents do not explicitly allocate or describe specific funding from the national budget to address identified gaps in the Joint External Evaluation (JEE) report, a National Action Plan for Health Security (NAPHS), or a national GHSA roadmap.

While the JEE report identifies numerous gaps and makes recommendations, it does not include details on budget allocation for these specific areas. For instance, it generally mentions that "The Government allocates an average of 11-13% of the national gross domestic product to the health sector" (p. 5), but this is a broad statement regarding overall health funding, not specific allocations for the identified gaps. ⁵²⁴

The National Health Strategic Plan (NHSP) 2022-2026 mentions the NAPHS, stating that it "will guide the process to strengthen this multi-sectoral collaboration" (p. 56). However, the NAPHS document itself is not ready. The NHSP discusses health financing in broader terms under its "Invest for Results" strategic direction, noting that "The government has always been and remains the principal investor in health" (p. 72) and aiming to "Mobilise funds to ensure adequate financing of interventions in the NHSP" (p. 44). However, it also acknowledges that "The health budget is unlikely to increase substantially in the next few years" (p. 102) and that a risk is "Budget allocation for health not commensurate with health needs," with mitigation strategies focusing on advocacy and mobilizing funds from partners (p. 102). This suggests that specific national budget allocations for addressing identified gaps in documents like the JEE or NAPHS are not clearly detailed. ⁵²⁵

Furthermore, the Infection Prevention and Control Strategic Framework 2021-2025 explicitly states that "The IPC unit has an annual plan but has no dedicated budget line and is heavily dependent on donor support" (p. 7). It also emphasizes the "importance of having a budget line (domestic funding) for IPC programmes at both national and health facility levels" and the need to "advocate and identify additional resources of funding" due to reliance on donor support (p. 16). This indicates a clear absence of dedicated national budget funding for a crucial area related to health security gaps. ⁵²⁶

The Annual Health Sector Performance Report 2023 provides a general budget allocation for the health sector and its entities (p. 4, 21), but does not break down these allocations to specifically address gaps identified in strategic documents like the JEE or the NAPHS. ⁵²⁷

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

Score: 0

Seychelles has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. ⁵²⁸

5.5.3a Emergency public financing during a public health emergency

Score: 100

Seychelles possesses publicly identified special emergency public financing mechanisms and funds that can be accessed during a public health emergency.

According to the Joint External Evaluation (JEE), a "contingency fund is in place for emergency response operations" (p. 35). This fund signifies a dedicated financial resource specifically established to address urgent needs during crises. Furthermore, the JEE states, "There is a National Disaster Fund in the event of any emergency" (p. 37). This indicates the existence of another specific fund designed to provide financial support for a broader range of emergency situations. ⁵²⁹

The National Integrated Emergency Management Plan (NIEMP) details the administrative and operational framework for managing resources, including financial aspects, during emergencies. Under "Functional Area V: Emergency Management," Task 5.3, titled "Legal and Administrative Affairs," the NIEMP outlines its purpose to "Ensure that the operations and actions carried out in response to an emergency are executed with the guidance and support of the current legal framework and ensure that the allocation of resources is executed with technical criteria of foresight and rationality, in accordance with disaster scenarios" (p. 50). The scope of this task includes "the execution of the resources in an efficient way so that the operations are supported by the appropriate economic and legal framework, based on the decisions of the Command Post—NEOC Gold—Platinum Command and the articulation of the different levels of government" (p. 50). The Department of Risk and Disaster Management (DRDM) is identified as the lead government agency for this task, with the Department of Finance and the Attorney General as supporting agencies, underscoring a formalized process for financial management during emergencies (p. 50). ⁵³⁰

Additionally, the NIEMP addresses the acquisition of further financial resources through Task 5.8, "Resource Management." The purpose of this task is to "Determine the needs of the affected community and the agencies in charge of response and rehabilitation, according to the post-disaster damage assessment, comparing this information with the existing capacities, in order to determine the need to provide additional resources and establish different acquisition options (purchase, loans, agreements, contracts, and/or national or international appeals for aid)" (p. 51). This mechanism allows Seychelles to seek financial and material support from various avenues, including international appeals, if national resources prove insufficient. The DRDM leads this effort, supported by the Department of Finance and other key stakeholders, ensuring a coordinated approach to resource mobilization (p. 51). ⁵³¹

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

Score: 0

There is no clear evidence that senior leaders in Seychelles have made specific public commitments in the past three years to provide financing or support to other countries to address pandemic or epidemic threats. Furthermore, while there are indications of general health investments and collaboration efforts, there is no direct evidence of senior leaders explicitly expanding domestic financing or requesting specific support dedicated to addressing pandemic or epidemic threats.

Regarding support for other countries, the Ministry of Health, under the leadership of its Minister, hosted a significant regional event. In May 2023, the Ministry of Health hosted the 3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs), according to the Annual Health Sector Performance Report 2023. This workshop was organized in collaboration with key international partners and saw the participation of forty-two individuals from twenty-seven countries and regional bodies across Africa. The primary objective of this initiative was to strengthen PHEOCs in the respective participating countries, including through training others at sub-national levels in incident and PHEOC management. While Seychelles hosted this "training of trainers" workshop on Public Health Emergency Operations Centres (PHEOCs) in May 2023, this event—organized in collaboration with international partners—focused on capacity-building for regional participants from 27 countries and does not appear to involve Seychelles committing specific financing for pandemic or epidemic preparedness in these other countries (p. 37). Instead, it reflects Seychelles' facilitation of knowledge sharing but does not meet the criteria of direct financial support.⁵³²

Concerning the improvement of Seychelles’ domestic capacity, senior leaders in Seychelles have not publicly committed to expanding specific financing to address pandemic or epidemic threats, although general health sector investment remains a consistent national priority. The government allocated 13% of its 2023 budget (1.38 billion SCR) to health (p. 4). However, this allocation does not explicitly target pandemic or epidemic preparedness. Commitments outlined in the foreword of the 2023 Annual Health Sector Performance Report—such as expanding digital health information systems, advancing infrastructure projects, and addressing staffing gaps—are broader investments in health infrastructure rather than specific financing targeting pandemics or epidemics (p. 3). ⁵³³

The 2023 Annual Health Sector Performance Report details that "a visit from the Regional Director for Africa Centres for Disease Control (ACDC) in October 2023 opened doors to further collaboration. The visit concluded with an agreement to deploy staff to support the Ministry where capacity gaps exist. While Seychelles did engage external partners to secure the deployment of specialists (e.g., epidemiologists and a health informatics specialist starting in 2024) to fill capacity gaps (p. 15), this initiative reflects efforts to address general public health needs rather than pandemic-specific threats. ⁵³⁴

In July 2023, Seychelles leveraged the IMF Resilience and Sustainability Facility (RSF) to enhance its capacity for climate and health resilience. However, this funding primarily addresses climate-related risks and strengthening overall health security infrastructure; it is not directly tied to pandemic or epidemic preparedness. ⁵³⁵

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

Score: 100

While Seychelles has contributed to regional capacity-building efforts and sought technical support for improving its health sector, there is no explicit evidence of financing or technical support activities specifically targeting epidemic threats. Most initiatives focus on general health security, emergency preparedness, or broader health system strengthening rather than being directly tied to managing or mitigating epidemic threats.

Regarding providing support to other countries, in May 2023, the Ministry of Health (MOH) hosted the 3rd African Regional ‘training of trainers’ workshop on Public Health Emergency Operations Centres (PHEOCs), according to the Annual Health Sector Performance Report 2023. This initiative was conducted in collaboration with international partners and involved forty-two participants from twenty-seven African countries and regional organizations. The main goal of this training was to strengthen PHEOCs in these countries, including the development of local capacity for incident and PHEOC management (p. 37). While this event focused on strengthening PHEOCs and incident management capacities in 27 African countries and regional bodies, the primary scope involved general health emergency preparedness rather than targeting epidemic-specific threats. ⁵³⁶

Additionally, Seychelles collaborated with the Commonwealth on capacity building for climate change financing and Digital Health Maturity Assessments, and with the Indian Ocean Commission on the Réseau SEGA platform, which supports regional epidemiologic surveillance (p. 15). This collaboration aligns more broadly with improving public health systems rather than addressing epidemic threats explicitly.⁵³⁷

Concerning the request and receipt of support for domestic capacity, Seychelles has actively engaged with international partners. In October 2023, a visit from the Regional Director for Africa Centres for Disease Control (ACDC) led to an agreement for the deployment of staff to support the Ministry of Health in areas with capacity gaps. This included the planned arrival of two epidemiologists and one health informatics specialist in 2024 to work within the Ministry's teams (p. 15). While these roles are beneficial for epidemic surveillance and management, the deployment is framed more broadly as capacity building within Seychelles' health sector rather than a targeted epidemic-preparedness effort. ⁵³⁸

Furthermore, the National Digital Health Maturity Assessment (DHMA) conducted in October 2023 was supported by experts from the World Health Organization (WHO) and the Commonwealth Secretariat, providing technical assistance to inform the development of Seychelles' digital health strategy (p. 15, 16). The WHO also provided training for the revitalization of the National Health Workforce Accounts (NHWA) and for the Workload Indicators of Staffing Needs (WISN) in 2023, aimed at improving health workforce data quality and planning (p. 15). Specific programs have also received technical support, such as capacity-building on research design for program managers with assistance from the WHO and the University of Oxford (p. 62). Improved digital health systems could indirectly support epidemic threat management by bolstering surveillance capacities and response systems, but this initiative is not explicitly described as addressing epidemics ⁵³⁹

The United Nations Sustainable Development Cooperation Framework for Seychelles 2024-2028, signed by the Minister for Foreign Affairs and Tourism, outlines a comprehensive program of support from the United Nations Development System to strengthen the country's resilience to shocks, including investments in data and health information systems to boost preparedness (p. 2, 6, 20, 39). While these efforts may enhance national capacity for health emergencies, the document does not make explicit reference to epidemic-specific investments. ⁵⁴⁰

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

Score: 100

Based on the Statement of Account for Seychelles as at 30 June 2025, there is evidence that the country has fulfilled its full assessed contributions to the WHO within the past two years.

The document lists assessed contributions and corresponding receipt applications for the years 2023, 2024, and 2025. For the 2023 assessed contribution of USD 9,570, a receipt application of USD 9,570 was recorded on 5 April 2023. For the 2024 assessed contribution of USD 11,490, a receipt application of USD 11,490 was recorded on 20 May 2025. For the 2025 assessed contribution of USD 11,480, a receipt application of USD 11,480 was recorded on 9 June 2025. The Statement of Account also shows a "Balance Outstanding" of "-", indicating that all assessed contributions, including those for the past two years, have been fully paid as of 30 June 2025. ⁵⁴¹

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

Score: 0

There is no publicly available evidence in the provided documents of a comprehensive plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organizations and/or other countries that goes beyond influenza. While there is evidence of some international collaboration and informal relationships, a formal and publicly accessible policy outlining such sharing mechanisms is not detailed.

The Joint External Evaluation (JEE) report from March 2018 indicates that Seychelles has "informal relationships with regional and international laboratories including the National Institute for Communicable Diseases (NICD) in South Africa, Institute Pasteur in Madagascar and Paris, the US Centers for Disease Control (CDC) in Atlanta, and others" (p. 24). However, this same report explicitly states, "The country needs to establish a framework for national external quality assurance and proficiency testing for priority diseases" and recommends to "Finalise MOUs with regional laboratories to formalise access to advanced diagnostics, confirmatory tests and buffer stocks of reagents" (p. 24). ⁵⁴²

The Annual Health Sector Performance Report 2023 mentions that "Dengue serotype testing showed that serotype 1 was the primary circulating serotype in 2023, and sequencing of COVID-19 for samples spanning October 2022 to July 2023 showed the primarily circulating strain…to be Omicron" (p. 38). This implies that samples were sent to referral centers for specialized testing like sequencing, but it does not describe a publicly available policy governing the routine sharing of genetic data, clinical specimens, or isolated biological materials and their associated epidemiological data with international partners for a broader range of diseases. The report also highlights participation in the "Réseau SEGA surveillance of climate-sensitive health risks" for "regional epidemiologic surveillance" (p. 15, 36), but this relates to epidemiological data for surveillance rather than genetic or isolated biological materials. ⁵⁴³

The National Health Strategic Plan (NHSP) 2022-2026, under its "Improve Data for Impact" strategic direction, includes "Develop a data sharing policy" as a key intervention for improving data governance, with a milestone of it being "developed and disseminated" (p. 88). ⁵⁴⁴ This is presented as a future milestone, indicating that such a policy was not yet fully established or publicly available at the time the NHSP was drafted. Furthermore, none of the other national documents like the Seychelles National Integrated Emergency Management Plan and the Infection Prevention and Control Strategic Framework 2021-2025 contain information regarding a publicly available plan or policy for sharing genetic data, clinical specimens, or isolated biological materials with international organizations or other countries beyond influenza. ⁵⁴⁵⁵⁴⁶

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

Score: 100

Publicly available evidence indicating that Seychelles 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 Seychelles and WHO communications does not reveal any explicit public statements or reports of non-compliance by Seychelles regarding sample sharing under the PIP Framework in the specified timeframe. ⁵⁴⁷

No other relevant evidence was found on the website of the Ministry of Health. ⁵⁴⁸

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

Score: 100

Seychelles has actively shared pandemic pathogen samples during outbreaks in the past two years.

Specifically, the Annual Health Sector Performance Report for 2023 provides public evidence of sample sharing. It states that "Through the NICD referral centre, Dengue serotype testing showed that serotype 1 was the primary circulating serotype in 2023, and sequencing of COVID-19 for samples spanning October 2022 to July 2023 showed the primarily circulating strain (>99% of 118 samples sequenced) to be Omicron (specifically clade 22E/BQ.1)" (p.38). This explicitly indicates that samples from both Dengue and COVID-19 outbreaks were sent to an external entity, the NICD (National Institute for Communicable Diseases), for testing and sequencing during the specified period. ⁵⁴⁹

The Joint External Evaluation of IHR Core Capacities report from 2018 also notes that "Seychelles has informal relationships with regional and international laboratories including the National Institute for Communicable Diseases (NICD) in South Africa" (p.24) and that "There is a functional system in place to ship specimens to identified reference laboratories if national laboratories are unable to provide the required testing or confirmation capacity" (p.24). This confirms the practice and capability of sharing pathogen samples with international reference laboratories for diagnostic and surveillance purposes. ⁵⁵⁰

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 50

6.1.1c Excessive bureaucracy/red tape

Score: 50

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 72

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: 75

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: 75

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

Score: 99.68

6.2.2a UNDP Gender Inequality Index score

Score: 0

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

Score: 98.68

6.2.3b Share of employment in the informal sector

Score: 100

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

Score: 0

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 67.9

6.3.1a Adequacy of road network

Score: 75

6.3.2a Adequacy of airports

Score: 75

6.3.3a Adequacy of power network

Score: 50

6.4.1a Urban population (% of total population)

Score: 42.11

6.4.2a Change in forest area (percentage points)

Score: 76.33

6.4.3a Natural disaster risk

Score: 0

6.5.1a Total life expectancy (years)

Score: 92.97

6.5.1b NCD mortality rate

Score: 87.78

6.5.1c Population aged 65+

Score: 43.07

6.5.1d Tobacco use (% of adults)

Score: 24.7

6.5.1e Level of adult obesity (%)

Score: 0

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

Score: 92.34

6.5.2a Access to potable water

Score: 98

6.5.2b Access to at least basic sanitation facilities

Score: 100

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: 100

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