Introduction: The 2014 Ebola virus disease (EVD) outbreak in West Africa was the largest in history, exposing critical weaknesses in surveillance, health systems, and cross-border coordination. A decade later, regional institutions have implemented numerous initiatives to strengthen preparedness and response capacities for Ebola and other viral hemorrhagic fevers (VHFs). This paper reviews progress, lessons learned, and ongoing challenges in VHF preparedness and response across West Africa, based on the outcomes of a regional workshop organized by the West African Health Organization (WAHO) and the World Health Organization (WHO) in July 2024. Methods: A qualitative thematic analysis of workshop proceedings was conducted, encompassing country presentations, panel discussions, and group work sessions with representatives from 15 West African countries, the WHO, Africa CDC, UNICEF, Médecins Sans Frontières, the World Bank, and other key regional stakeholders. Data were analyzed to identify common themes related to achievements, gaps, challenges, and strategic priorities for strengthening regional preparedness and response. Results: Key lessons highlighted the importance of resilient health systems, early detection, cross-border collaboration, community engagement, and sustainable financing. Progress over the past decade includes the establishment of Public Health Emergency Operations Centres (PHEOCs), expanded surveillance and laboratory networks, capacity-building initiatives, and deployment of Ebola vaccines. Nonetheless, significant challenges remain, including limited laboratory capacity in rural areas, inadequate treatment centres, weak cross-border coordination, and dependency on external funding. Conclusion: Ten years after the West Africa Ebola outbreak, substantial gains have been made in preparedness and response capacities, but critical gaps persist. Sustained investments in laboratory systems, community engagement, and cross-border collaboration, supported by predictable domestic and regional financing, are essential to build resilient health systems and prevent future outbreaks.
Implementation science, although promising to bridge the know-do gap in global health, has inadvertently created new forms of epistemic exclusion in African health systems. In this Viewpoint, we present an empirical critique of how widely used implementation frameworks, rooted in Eurocentric and North American epistemologies, systematically fail to recognise the mechanisms through which successful implementation occurs in African contexts. Drawing on case studies across diverse African settings, we reveal how this epistemological mismatch undermines both the science and practice of implementation in African health systems. Using epistemic injustice theory, we show how frameworks operationalise constructs in ways that treat traditional governance, community legitimacy, and relational authority as peripheral variables rather than generative mechanisms of change. We propose concrete transformations to implementation science that centre African epistemological traditions and require genuine power-sharing in knowledge production to support health system improvement across all contexts.
Introduction: The One Health approach recognizes the interconnectedness of human, animal, and environmental health and the need for cross-sectoral collaboration to address zoonotic diseases and emerging public health threats. Integrating this concept into training programs enhances the capacity of health systems to detect, prevent, and respond to complex health challenges. The Field Epidemiology and Laboratory Training Program (FELTP) Frontline model, widely used to strengthen health systems and improve surveillance and response, was adapted in The Gambia to incorporate a One Health approach following regional mentor training by the ECOWAS Regional Centre for Surveillance and Disease Control. Methods: The Gambia’s One Health FELTP Frontline cohort recruited participants from human health, veterinary, and environmental sectors. The training combined classroom instruction with field-based activities focused on disease surveillance, data quality audits, outbreak investigation, fishbone problem analysis, zoonotic disease epidemiology, laboratory techniques, and integration of human-animal health data. Partnerships with national ministries and agencies supported practical learning and sectoral collaboration. Results: The program successfully trained multidisciplinary professionals equipped to lead outbreak responses across sectors. Graduates conducted joint investigations of zoonotic disease outbreaks and contributed to national surveillance activities. The initiative fostered strong collaboration between public health, veterinary, and environmental institutions, improving coordinated responses to health threats. Conclusion: The Gambia’s One Health FELTP Frontline cohort demonstrates the value of integrated, cross-sectoral training in strengthening national health systems. By building a skilled, multidisciplinary workforce, the program enhances sustainable disease control and supports a holistic approach to public health.
Introduction: The West African Health Organization (WAHO), through the Regional Center for Disease Surveillance and Control (RCSDC), collaborated with the US CDC and AFENET to conduct a one-day consultative workshop on November 8, 2023, in Mombasa, Kenya. The workshop brought together FETP country directors, coordinators, resident advisors, partners, and experts from ECOWAS member states. Its objectives were to analyze the current state of FETP programs in the region and propose strategic priorities for the 2026-2030 regional workforce development plan. Methods: Before the workshop, member states completed a situational analysis questionnaire. During the workshop, participants reviewed a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of FETP programs and engaged in group discussions. These activities helped identify key regional strategies and activities for the 2026-2030 strategic plan. Results: Thirty participants, including representatives from all 15 ECOWAS countries and key partners, attended the workshop. The situational analysis revealed strengths such as strong capacity-building practices, One Health training, policy frameworks, and university affiliations for advanced programs. However, weaknesses included poor documentation of best practices, weak resource mobilization, lack of FETP institutionalization, limited career pathways for graduates, and unstable funding. Key opportunities included AFENET’s networking support, ECOWAS advocacy structures, university partnerships, and regional training centers. Conclusion: Despite challenges in FETP implementation, the workshop successfully identified critical strategies for strengthening workforce development in the ECOWAS region. Recommendations included improving documentation, securing sustainable funding, institutionalizing FETP programs, and leveraging regional partnerships for long-term success.
Introduction: Recent global economic crises, pandemics, and climate change have exposed weaknesses in health systems, particularly at the community level. In response, the West African Health Organization (WAHO) conducted a regional situational analysis to inform updates to its community health strategy, emphasizing social determinants of health (SDH), multisectoral collaboration, and the “Health in All Policies” (HiAP) approach. Methods: A cross-sectional study was carried out in 13 ECOWAS countries using a standardized tool developed by WAHO. Data were collected from September to November 2023 through self-administered questionnaires, document reviews, and stakeholder interviews. Thematic content analysis was used to identify key trends. Results: All countries reported using data-driven approaches, but few had community-specific HRH systems or fully adopted MEAL frameworks. Two CHW categories were common—professionals and volunteers—though core competencies were often misaligned with SDH. Financing remained inconsistent, and HiAP strategies lacked full implementation. Conclusion: Significant gaps exist in institutional frameworks, financing, and workforce capacity across West Africa. An integrated, SDH-focused model with strengthened CHW systems and multisectoral policies is critical to achieving equitable and effective community health outcomes.
