Assessment of National Capacities for Health Emergency Preparedness and Response: Current Challenges and Strategic Opportunities for Strengthening

Introduction In the wake of recent epidemics and public health emergencies that have impacted Togo including cholera, COVID-19, and Lassa fever numerous systemic weaknesses have been revealed within the national health system. These crises have underscored the urgent need to build health system resilience and strengthen the country’s capacity to anticipate, detect, and respond effectively to such threats. This study adopts the WHO Health System Framework and the International Health Regulations (IHR, 2005) as guiding models to assess preparedness and response capacities. The WHO framework emphasizes six building blocks governance, service delivery, health workforce, information, medical products and technologies, and health financing while the IHR outlines twelve core capacities essential for health security. These frameworks provide a structured lens for analyzing system-level performance and identifying areas for improvement. Research Objective The primary objective of this study is to evaluate the readiness and capacity of Togo’s national health system to effectively manage health emergencies. It aims to assess the system’s preparedness across the twelve thematic areas defined by the International Health Regulations (IHR), identify institutional, technical, and operational gaps that hinder efficient epidemic prevention, detection, and response, and analyze the effectiveness of coordination mechanisms, including multisectoral and decentralized structures, during crises. Additionally, the study examines the role and contributions of technical and financial partners in strengthening national health capacities and proposes actionable recommendations to enhance preparedness, surveillance, and response systems in accordance with global standards. Methodology This study employed a qualitative descriptive research design, appropriate for examining complex health system dynamics within their contextual realities. Data collection was carried out through a comprehensive review of relevant documents, including national policy frameworks, health sector plans, WHO reports, and Joint External Evaluation (JEE) assessments. In addition, 15 semi-structured key informant interviews were conducted with purposively selected stakeholders from the Ministry of Health, technical departments such as the PHEOC and epidemiology units, donor organizations including WHO, UNICEF, USAID, and CDC, as well as civil society actors. Purposive sampling ensured representation across national, regional, and community levels to capture a wide range of perspectives. Thematic content analysis was used to code and interpret the data, guided by the twelve core capacities of the International Health Regulations (IHR, 2005). Interview transcripts were manually coded, and illustrative quotes were extracted to support and validate the identified themes. Results Thematic analysis of Togo’s preparedness and response system highlights notable strengths and persistent challenges. Key strengths include the existence of a national strategic health development plan (PNDS 2023–2027), a functional Public Health Emergency Operations Center (PHEOC) staffed with trained personnel, the implementation of the Field Epidemiology Training Program (FETP) to strengthen workforce capacity, and strong political will supported by active international partnerships. However, the system faces several challenges, including weak multisectoral coordination despite the institutionalization of the “One Health” approach, the absence of a formal mechanism for rapid human resource deployment during emergencies, limited sustainable domestic financing with significant reliance on external donors, disparities in risk communication between national and local levels, and fragmented data systems lacking interoperability. Emerging vulnerabilities further complicate response efforts, notably the high turnover and migration of trained personnel, inconsistent application of international standards across health regions, and the weak institutionalization of simulation exercises and after-action reviews necessary for continuous improvement. Keywords: Assessment, health security, preparedness, response, one health, International Health Regulations, Togo.