Operationalising regional public health in Africa: The contributions of the West African Health Organization

Public health in Africa is at a critical juncture. Debates over securing population health have swung between strengthening national systems and building pan-African institutions. Today, cross-border disease transmission, the transnational determinants of health (from migration to climate change), and the need for coordinated health diplomacy show that neither national approaches nor international aid alone are sufficient. A third approach, placing regional institutions at the center of public health governance, is essential. The West African Health Organization (WAHO), the specialised health agency of the Economic Community of West African States (ECOWAS), illustrates this model by combining technical coordination, policy harmonization, capacity building, and practical support in contextually appropriate ways. This perspective advances three key claims. First, many public health challenges in Africa are inherently regional; second, WAHO demonstrates how a regional institution can add value without replacing national responsibilities; third, scaling this model across the continent requires investments in institutional capacity, financing, and political frameworks that support regionalism in health. We discuss WAHO’s contributions, structural challenges, and strategies to strengthen regional public health governance in Africa. We refer to layered governance as the coordinated interaction of national, regional, continental, and global public health actors. These experiences are discussed in the context of Africa’s New Public Health Order, a strategic framework promoted by the Africa Centres for Disease Control and Prevention to strengthen health security, local manufacturing, and resilient health systems across the continent.