A newly released study jointly conducted by the Africa Centres for Disease Control and Prevention (Africa CDC) and the UK Public Health Rapid Support Team (UK-PHRST) reveals that international public health deployments have significantly strengthened outbreak preparedness and response capacities in African Union (AU) member states. The findings also underscore persistent challenges in sustainability, coordination, and long-term impact.
The comprehensive evaluation, conducted between March 2023 and November 2024, assessed the contributions and impacts of international deployments, defined as the placement of multidisciplinary experts by international agencies to support disease outbreaks, in 25 African countries. The report focused on both the short- and long-term contributions of these deployments and drew insights from two in-depth case studies in Namibia and Nigeria.
Understanding the Scope and Purpose
The study’s primary goal was to uncover whether international deployments had a long-term impact on outbreak preparedness and response capacity in the countries where they were deployed. It focused on three major objectives:
- To explore uptake and sustainability of deployments in a country’s outbreak response capacities.
- To assess national perspectives on the value/ contribution of deployments of international experts/teams within their countries in their response to and preparedness for outbreaks.
- To assess the perspectives of other key stakeholders including the deployees, incident managers, deploying organisations on the value of the contributions made through these deployments.
Using a mixed-methods approach, including literature reviews, surveys, in-depth interviews, and case studies in Nigeria and Namibia, the study captured perspectives from a wide range of stakeholders including Ministries of Health (MoH), National Public Health Institutes (NPHIs), deployees, local public health officers, and international organizations.
Short-Term Gains
The study found that deployments delivered substantial short-term results in several critical response areas. These included epidemiology, infection prevention and control (IPC), surveillance, laboratory capacity, risk communication, and clinical case management.
Of the 72 deployment activities reviewed, nearly half contributed to two or more of these response components. Stakeholders consistently cited improvements such as the provision of personal protective equipment (PPE), mobile laboratories, the development of disease surveillance systems, training of local personnel, and enhanced coordination of response activities.
In countries like Zambia and Malawi, deployees supported the establishment of emergency operations centres and Cholera Treatment Units, respectively. Similarly, in Uganda, the Africa CDC trained 1,000 community health workers in surveillance practices during an Ebola outbreak, leaving behind skills that continue to benefit communities.
Importantly, 82% of survey respondents said that the most recent deployment they were involved in fully met its objectives, while 90% rated the deployees’ contributions as helpful. However, external stakeholders expressed a degree of skepticism, noting that the effectiveness of a deployment often depended on the skills and integration of the individual deployees.
Long-Term Impact
While the academic literature remains sparse on the long-term effects of such deployments, the report found encouraging evidence of enduring impact.
A remarkable 77% of participants felt that recent deployments had fully contributed to strengthening their country’s public health emergency response systems. Another 84% said these efforts had supported sustainable changes in outbreak management, citing improved infrastructure, national policies, and cross-sector coordination.
In Nigeria, the study documented the establishment of laboratory networks and SOPs for sample selection and transport, which have since been utilized in subsequent outbreaks. Namibia’s case illustrated similar gains, including improved sub-national surveillance and the establishment of public health emergency centres.
Deployments also contributed to intangible yet critical developments: the growth of leadership, institutional confidence, and the emergence of a knowledge-sharing “community of practice” across borders.
Barriers to Sustainability
Despite the gains, the report flagged key barriers to sustaining impact. One major concern was the overreliance on individual knowledge rather than institutional systems. In several countries, learnings from deployments were stored informally, on personal laptops, rather than centralized repositories, making institutional memory vulnerable to staff attrition.
Moreover, the lack of political will and bureaucratic delays in releasing funds were identified as significant constraints. While countries have made progress, many stakeholders emphasized the need for rolling budgets that enable flexible, rapid responses to emerging health threats.
Another recurring theme was the limited role of national institutions in shaping the deployment process. Currently, many receiving countries have little input on the selection, duration, or scope of deployments. Respondents called for tailored deployment plans, clear key performance indicators, and greater alignment with national needs.
Key Recommendations
The report outlines 15 recommendations to enhance the impact and sustainability of international deployments. These are grouped into three categories:
For Deploying Agencies
- Ensure comprehensive pre-deployment preparation covering cultural, political, and health system contexts.
- Match deployees’ expertise with national needs, including flexible skills for dynamic outbreak scenarios.
- Establish robust knowledge management systems to document and share lessons learned.
- Facilitate learning exchanges, allowing personnel from receiving countries to serve as deployees elsewhere.
- Advocate for engagement with local institutions, including academia and civil society.
- Formalize capacity-building components within every deployment.
- Be flexible with deployment durations to reflect the scale of outbreaks.
- Develop a shared impact evaluation framework for systematic assessment of deployment effectiveness.
For National Governments (MoHs/NPHIs)
- Assume a central leadership role in deployment planning and coordination.
- Create tailored deployment plans, including triggers, communication channels, and logistical arrangements.
- Leverage domestic institutions to ensure continuity and contextual knowledge.
- Define clear Key Performance Indicators (KPIs) beyond standard ToRs to track deployment outcomes.
For Strengthening National Systems
- Institute rolling budgets to allow for rapid outbreak response without bureaucratic delays.
- Address the human resource crisis through accelerated training and financial incentives to retain skilled workers.
- Establish or strengthen knowledge management systems across the outbreak response ecosystem.
A Call for Mutuality and Shared Ownership
The report challenges the traditional narrative of international deployments as acts of external aid, advocating instead for a model rooted in solidarity and mutual growth. A study participant captured this sentiment aptly:
“This is not primarily an altruistic effort of one helping the other, but a means of solidarity … and mutually, we have forged improvement in our collective health security.”
In the wake of COVID-19 and recurrent public health emergencies, the need for strategic, collaborative international engagement has never been more urgent. As countries across Africa and the global community look ahead, the lessons from this study offer a roadmap for transforming emergency response from reactive support into lasting resilience.
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