Evaluation of Joint External Evaluation to COVID-19 and other infectious diseases mortality outcomes in 96 countries

Abstract Background This study assessed the association between Joint External Evaluation (JEE) scores and Covid-19 and other infectious diseases performance in 96 countries. To propose a revised JEE tool, potential JEE indicators were also examined. Methods The JEE scores were extracted across 96 countries from 2016 to 2019. We used Covid-19, fatality rate, infections per million, and deaths per million as main outcomes. Influenza, pneumonia, HIV, tuberculosis, malaria, Hepatitis B, and childhood vaccinations were included as other infectious diseases performance. Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) index and others were reviewed as potential JEE indicators. We used multiple regression to assess the association between JEE scores and Covid-19 and infectious diseases performance. Then, Covid-19 outcomes and influenza and pneumonia mortality rates were regressed on potential JEE indicators. Results An average JEE score was 2.70 (SD = 0.92) in 96 countries. The detection (3.23) and other areas (2.30) sections received the highest and the lowest score, respectively. A positive association between the Covid-19 outcomes and the JEE scores was found. However, JEE scores and the other infectious diseases performance showed a negative association. The SDGs 2,4, and 8 were strongly associated with Covid-19 outcomes. Conclusion The JEE scores showed poor predictive value against the Covid-19 mortality outcomes in 96 countries. Thus, a revised JEE tool is needed to better prepare for future public health crisis.