Establishment of Subnational Public Health Emergency Operation Centers During the COVID-19 Pandemic, Kenya, 2020-2023

The World Health Organization (WHO) assessment of the implementation status of national public health emergency operation center (PHEOCs) showed that African countries have made considerable efforts in setting up PHEOCs at national level. In 2017, Kenya established a national PHEOC to fulfill WHO Joint External Evaluation recommendations and as part of Ebola preparedness activities. In 2020, the COVID-19 pandemic provided an opportunity to establish subnational PHEOCs, as recommended by the national COVID-19 task force. We documented experiences in establishing and operationalizing subnational PHEOCs using contemporaneous start-up notes, PHEOC monthly reports, quarterly support supervision reports, outbreak reports, and baseline and follow-up standardized assessments adapted from WHO. From October 2020 through September 2021, PHEOCs were established in 17 of the 47 counties; priority was based on the burden of COVID-19 and other infectious diseases, population size, and proximity to an international border, among other factors. Existing physical structures were repurposed and supplied with communications equipment and furniture to host the PHEOCs. County government public health workers were deployed to PHEOCs to coordinate responses through an incident management system. Technical capacity was built through in-person training, virtual webinars, and onsite mentorship. National PHEOC plans and standard operating procedures were adapted to guide operations. Repurposed structures for PHEOCs and deployment of existing county health staff were seen as key sustainable best practices. Local government buy-in was critical to the establishment of subnational PHEOCs, which have been utilized to respond to 79 events during 2020-2023. The establishment of subnational PHEOCs strengthened local public health capacity to respond to COVID-19 and outbreaks of other diseases in Kenya. Lessons from Kenya may help other countries looking to establish subnational PHEOCs.