From rooms to intelligence: Reclaiming preparedness in Africa's public health emergency operations centres

Most African Union Member States have established Public Health Emergency Operations Centre (PHEOC) facilities, yet only 29% meet World Health Organization (WHO) minimum functionality criteria—infrastructure exists, but intelligence does not. This gap matters because preparedness requires not only buildings and equipment but continuous analytic function: the capacity to translate surveillance signals into timely decisions every day, not only during declared emergencies. This perspective proposes that African governments establish Preparedness Intelligence Units (PIUs)—dedicated four-person analytical teams working daily within PHEOCs. PIUs integrate data from electronic Integrated Disease Surveillance and Response (eIDSR) on District Health Information Software 2 (DHIS2), national laboratory networks, and climate systems to produce daily dashboards, weekly probabilistic forecasts, monthly risk briefs, and quarterly simulation reviews. Published country experiences and regional simulation findings suggest that performance gaps in detection, notification, and early-response timelines are measurable and addressable through standing analytic capacity, though a causal benefit of the PIU model has not yet been demonstrated, and prospective evaluation is required. A minimum viable PIU can be established for an estimated United States Dollars (USD) 200,000–500,000 per year, depending on the country context—a planning estimate requiring validation in each setting. Success should be measured against three indicators: alert-to-response time (ART), forecast accuracy, and after-action review (AAR) closure rate. Governance prerequisites include inter-ministerial data-sharing agreements, role-based access controls, and clear retention and accountability rules. We call on African governments to initiate PIU pilots at the national level and in 2–3 demonstration districts, supported by domestic budget lines and Africa Centres for Disease Control and Prevention (Africa CDC) and WHO technical assistance, with independent evaluation at 12 and 24 months. A PHEOC should not be a room waiting for a crisis; it should be a system producing intelligence continuously.