Strengthening health security in the ECOWAS Region: A decadal progress assessment of national public health institutes (2015-2024)

Abstract Introduction: Over the past decade, the Economic Community of West African States (ECOWAS) region has made significant progress in establishing National Public Health Institutes (NPHIs), increasing from five of 15 countries in 2015 to 11 of 15 countries in 2024. NPHIs play a vital role in strengthening essential public health functions (EPHFs), such as surveillance, laboratory systems, workforce development, and emergency preparedness. This study assessed institutional maturity, core public health capacities, and regional health security trends using the International Association of National Public Health Institutes (IANPHI) Staged Development Tool (SDT) and complementary States Parties Self-Assessment Annual Reporting (SPAR) data. Methods: We conducted a multi-source institutional assessment using the IANPHI SDT covering 2015–2024. Data were collected from 11 ECOWAS NPHIs between 2022 and 2024 using a standardized SDT template containing seven domains and 34 indicators. Verification was conducted through a regional workshop attended by 11 NPHI Directors, representatives from emerging NPHIs, West African Health Organization (WAHO), Africa CDC, US CDC, and IANPHI. SPAR data (2021–2023) were used to contextualize regional health security capacities. Ethical approval was not required as no personal data were collected. Results: The number of established NPHIs in ECOWAS increased from five (33%) in 2022 to 11 (73%) in 2024. Based on SDT assessments, four NPHIs achieved advanced maturity, while seven were in the developing stage; none achieved “Leading Edge,” aligning with the corrected scoring framework. Domain scores showed the highest performance in governance/leadership and legal frameworks, while significant gaps persisted in financing, laboratory systems, and workforce capacity. SPAR scores increased modestly across the region from 48% (2021) to 51% (2023), reflecting incremental improvements in IHR core capacities but with wide country-level variability. Progress remained uneven due to differences in NPHI establishment timelines, legal mandates, and domestic financing levels. Conclusion: NPHI establishment in ECOWAS has expanded substantially over the last decade, yet significant disparities remain in institutional maturity and health security capacities. Strengthening laboratory systems, sustainable financing, and public health workforce development are regional priorities. Targeted investments, stronger political commitment, and structured peer learning mechanisms are essential to accelerate progress.