Abstract
<b><i>Introduction:</i></b> The 2016 self-assessment based on joint external evaluation (JEE) identified certain gaps, which prompted the need for additional improvement. This study attempted to address an approach to enhance preparedness using the performance management system’s components focusing on related areas in the JEE tool by the International Health Regulations (IHR). <b><i>Methods:</i></b> This was an observational cross-sectional study including all hospitals and regional health directorates within the Ministry of Health, Saudi Arabia. Entities preparedness was calculated using the JEE tool. Moreover, the implementation of the performance management system was also assessed for Saudi Arabia from the year 2017 to 2022. Additionally, the feedback was collected using the survey from the 11 National Preparedness Index (NPI) coordinators. <b><i>Results:</i></b> Total readiness was found to be 52% only, which was far less than the planned value of 75%. While regarding the implementation of the performance management system, it was noted that there was a progressive increase in the implementation from 10% in the year 2017 to 81.25% in the year 2022. Considering the feedback responses of NPI coordinators, it was found that 100% of coordinators agreed that the NPI has supported enhancing Health emergency preparedness and that the follow-up and support from the NPI team played an important role in NPI score improvement. <b><i>Conclusion:</i></b> The analysis indicated that while there are areas of progress, Saudi Arabia is still working on strengthening fundamental public health functions and emergency preparedness. This is evident when comparing a range of indicators with those of many countries under the purview of the World Health Organization (WHO).