Introduction:This study evaluates the Strategic Tool for Assessing Risks (STAR), developed by the World Health Organization (WHO), for its effectiveness in predicting public health emergencies across West and Central Africa during the period 2022-2024. STAR applies a composite risk scoring system based on four dimensions likelihood, severity, vulnerability, and coping capacity to classify hazards such as measles, cholera, and meningitis into five risk categories ranging from very low to very high. Methods:Using a retrospective observational design, the study integrates quantitative outbreak data with qualitative assessments of preparedness actions across nine countries. The analysis demonstrates that STAR's predictive accuracy varies significantly by hazard and context. Results:Meningitis forecasts were consistently accurate, primarily due to the disease's strong seasonality and well-established epidemiological patterns in the African meningitis belt. In contrast, predictions for measles and cholera were less reliable, influenced by fluctuating immunization coverage, socio-political instability, and environmental factors such as water and sanitation conditions. Case studies illustrate these discrepancies: Burkina Faso's cholera risk was overestimated, resulting in zero reported cases despite a high-risk classification, while Guinea's measles outbreak closely matched STAR's high-risk prediction. The findings also highlight that effective preparedness measures, including vaccination campaigns, hygiene promotion, and cross-border coordination, can mitigate high-risk scenarios, as observed in Gabon and Burkina Faso. Key themes emerging from the analysis include STAR's strength in forecasting predictable hazards and its limitations due to static inputs and low geographic granularity. Discussion:While STAR is not a statistical forecasting model, its participatory, multi-sectoral approach provides strategic value by guiding planning, prioritization, and resource allocation for health emergency preparedness. It enables countries to optimize limited resources, prioritize highrisk hazards (scores 16-25), and implement preventive actions. Recommendations for improvement include recalibrating scoring parameters, integrating real-time surveillance and climate data, enhancing seasonality modeling, and increasing geographic resolution. When combined with dynamic data systems and collaborative efforts, STAR remains a critical strategic tool for strengthening regional public health resilience and supporting WHO's Health Emergency Framework and all-hazards preparedness planning.

Madagascar regularly faces disasters and health emergencies. It is one of the countries vulnerable to various disaster risks and climate change. Since 2014, the country has been affected by large-scale epidemics and natural disasters. In order to strengthen prevention, preparedness, response, and resilience to health threats, the World Health Organization (WHO) recommends that countries conduct a health risk assessment and mapping as the first step in the emergency management cycle in the context of limited resources and update the risk profile every three years. The objectives are to identify and characterize the various priority health risks in Madagascar, assess the probability of their occurrence, estimate their potential impact, determine the estimated level of risk, categorize them, and map them in order to formulate key recommendations. This is a qualitative, multisectoral, and multi-hazard assessment, combined with national health risk mapping using the WHO's Strategic Tool for Assessing Risk (STAR). The first assessment was conducted in 2022, followed by an update of the health risk profile in 2025. The results obtained in 2022 identified 23 health threats out of the 96 identified. In 2025, during the update, 21 threats were retained, including 3 threats that were removed.

Following the West Africa Ebola virus disease outbreak (2013-2016), the Joint External Evaluation (JEE) is one of the three voluntary components recommended by the WHO for evaluating the International Health Regulations (2005) capacities in countries. Here, we share experience implementing JEEs in all 47 countries in the WHO African region. In February 2016, the United Republic of Tanzania (Mainland) was the first country globally to conduct a JEE. By April 2022, JEEs had been conducted in all 47 countries plus in the island of Zanzibar. A total of 360 subject matter experts (SMEs) from 88 organisations were deployed 607 times. Despite availability of guidelines, the process had to be contextualised while avoiding jeopardising the quality and integrity of the findings. Key challenges were: inadequate understanding of the process by in-country counterparts; competing country priorities; limited time for validating subnational capacities; insufficient availability of SMEs for biosafety and biosecurity, antimicrobial resistance, points of entry, chemical events and radio-nuclear emergencies; and inadequate financing to fill gaps identified. Key points learnt were: importance of country leadership and ownership; conducting orientation workshops before the self-assessment; availability of an external JEE expert to support the self-assessment; the skills, attitudes and leadership competencies of the team lead; identifying national experts as SMEs for future JEEs to promote capacity building and experience sharing; the centrality of involving One Health stakeholders from the beginning to the end of the process; and the need for dedicated staff for planning, coordination, implementation and timely report writing. Moving forward, it is essential to draw from this learning to plan future JEEs. Finally, predictable financing is needed immediately to fill gaps identified.

Objectives We conducted a review of intra-action review (IAR) reports of the national response to the COVID-19 pandemic in Africa. We highlight best practices and challenges and offer perspectives for the future. Design A thematic analysis across 10 preparedness and response domains, namely, governance, leadership, and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response, and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic. Setting All countries in the WHO African Region were eligible for inclusion in the study. National IAR reports submitted by March 2021 were analysed. Results We retrieved IAR reports from 18 African countries. The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and subnational levels. Conclusion These findings suggest that African countries’ response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared with countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks.

Background: The COVID-19 pandemic has continued to spread throughout the globe and in all African countries with major public health and economic impacts.Methods: We have conducted a detailed synthesis of intra-action review (IAR) reports from 18 countries in the World Health Organization (WHO) African Region, which were available as of March 2021. We conducted a thematic analysis across ten preparedness and response domains, namely, governance, leadership and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic.Findings: The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases, and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and sub-national levels. Interpretation: These findings suggest that African countries' response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared to countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks.Funding Information: World Health Organization Regional Office for Africa.Declaration of Interests: We declare no competing interests.

The International Health Regulations (IHR, 2005) are an essential vehicle for addressing global health security. Here, we report the IHR capacities in the WHO African from independent joint external evaluation (JEE). The JEE is a voluntary component of the IHR monitoring and evaluation framework. It evaluates IHR capacities in 19 technical areas in four broad themes: `Prevent' (7 technical areas, 15 indicators); `Detect' (4 technical areas, 13 indicators); `Respond' (5 technical areas, 14 indicators), points of entry (PoE) and other IHR hazards (chemical and radiation) (3 technical areas, 6 indicators). The IHR capacity scores are graded from level 1 (no capacity) to level 5 (sustainable capacity). From February 2016 to March 2019, 40 of 47 WHO African region countries (81% coverage) evaluated their IHR capacities using the JEE tool. No country had the required IHR capacities. Under the theme `Prevent', no country scored level 5 for 12 of 15 indicators. Over 80% of them scored level 1 or 2 for most indicators. For `Detect', none scored level 5 for 12 of 13 indicators. However, many scored level 3 or 4 for several indicators. For `Respond', none scored level 5 for 13 of 14 indicators, and less than 10% had a national multihazard public health emergency preparedness and response plan. For PoE and other IHR hazards, most countries scored level 1 or 2 and none scored level 5. Countries in the WHO African region are commended for embracing the JEE to assess their IHR capacities. However, major gaps have been identified. Urgent collective action is needed now to protect the WHO African region from health security threats.