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The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to “prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it”. There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.

In the midst of the West Africa epidemic, EVD was identified in the equatorial country of the Democratic Republic of Congo. Epidemiologic and molecular data show that the DRC outbreak is related to previous EVD outbreaks there and did not spread from West Africa. On August 24, 2014, when the eyes of the world were on the spreading West African outbreak of Ebola virus disease (EVD), the World Health Organization (WHO) was notified of another EVD outbreak in the vicinity of Boende town, Équateur province, in western Democratic Republic of Congo (DRC). Boende town lies 700 km northeast of the capital city, Kinshasa, and 300 km east of Mbandaka, the capital of Équateur province (Figure 1). The affected area is situated in humid tropical forest and delimited by two large rivers, which are the main channels for moving people and goods to and from . . .

Background The recent 2018 Declaration of Astana recognized primary health care (PHC) as a means to achieve universal health coverage (UHC) and the health-related Sustainable Development Goals (SDGs). Following this declaration, country progress on operationalization of the PHC agenda and attainment of UHC has been stalled by the new challenges posed by the COVID-19 pandemic. The pandemic has also disrupted the continuity of essential health service provision and tested the resilience of the region’s health systems. Methods In accordance with this, the WHO Regional Office for Africa convened the Fifth Health Sector Directors’ Planning and Policy Meeting across the 47 Member States of the Region. The two-day forum focused on building health system resilience to facilitate service continuity during health threats, PHC revitalization, and health systems strengthening towards UHC. Results The Regional Forum provided evidence on building resilient health systems in the WHO African Region and engaged participants in meaningful and critical discussion. It is from these discussions that four key themes emerged: (1) working multisectorally/intersectorally, (2) moving from fragmentation to integration, (3) ensuring implementation and knowledge exchange, and (4) rethinking resilience and embracing antifragility. These discussions and associated groupings by thematic areas lend themselves to recommendations for the WHO. Conclusions This paper details the proceedings and key findings on building resilient health systems, the four themes that emerged from participant deliberation, and the recommendations that have emerged from the meeting. Deliberations from the Regional Forum are critical, as they have the potential to directly inform policy and program design, given that the meeting convenes health sector technocrats, who are at the helm of policy design, action, and implementation.

The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been unprecedented in its speed and effects. Interruption of its transmission to prevent widespread community transmission is critical because its effects go beyond the number of COVID-19 cases and deaths and affect the health system capacity to provide other essential services. Highlighting the implications of such a situation, the predictions presented here are derived using a Markov chain model, with the transition states and country specific probabilities derived based on currently available knowledge. A risk of exposure, and vulnerability index are used to make the probabilities country specific. The results predict a high risk of exposure in states of small size, together with Algeria, South Africa and Cameroon. Nigeria will have the largest number of infections, followed by Algeria and South Africa. Mauritania would have the fewest cases, followed by Seychelles and Eritrea. Per capita, Mauritius, Seychelles and Equatorial Guinea would have the highest proportion of their population affected, while Niger, Mauritania and Chad would have the lowest. Of the World Health Organization's 1 billion population in Africa, 22% (16%–26%) will be infected in the first year, with 37 (29 – 44) million symptomatic cases and 150 078 (82 735–189 579) deaths. There will be an estimated 4.6 (3.6–5.5) million COVID-19 hospitalisations, of which 139 521 (81 876–167 044) would be severe cases requiring oxygen, and 89 043 (52 253–106 599) critical cases requiring breathing support. The needed mitigation measures would significantly strain health system capacities, particularly for secondary and tertiary services, while many cases may pass undetected in primary care facilities due to weak diagnostic capacity and non-specific symptoms. The effect of avoiding widespread and sustained community transmission of SARS-CoV-2 is significant, and most likely outweighs any costs of preventing such a scenario. Effective containment measures should be promoted in all countries to best manage the COVID-19 pandemic.

The use of geographic information system (GIS) technologies to improve access to health is gaining momentum in Africa. This has become more pertinent with the increasing penetration of mobile-phone technology and internet use, and calls for innovative strategies to support implementation of the World Health Organization Sustainable Development Goals for universal health coverage on the continent. The huge potential benefits of GIS to advance health service delivery in Africa is, however, yet to be fully harnessed due to critical challenges such as proliferation of pilot projects, poor coordination, inadequate preparedness of the health workforce for GIS, lack of interoperability, and inadequate sustainable financing. To discuss these challenges and propose the way forward for rapid, cost-effective, and sustainable deployment of GIS, the African Regional GIS Summit was held in Brazzaville, Republic of the Congo, on 7–10 October 2019 under the umbrella of the AFRO GIS Centre.

IntroductionAn adequate health workforce is one of the cornerstones of a healthy nation. Over the last two decades, Africa has gained momentum in mitigating critical health workforce gaps, but urgent actions are still needed to accelerate progress towards universal health coverage and ensuring health security. This analysis provides an overview of the health workforce in the WHO African Region for the last decade.MethodsData were extracted and triangulated from the National Health Workforce Accounts (NHWA), health labour market analyses, countries’ human resources for health (HRH) profiles, HRH strategic plans and annual reports. A descriptive analysis of health worker stock, training capacity and unemployment levels was undertaken. The density of health workers was calculated per 10 000 population for each country and examined by occupational groups and income levels of the countries to provide a more comprehensive understanding of the health workforce dynamics.ResultsThe stock of the health workforce progressively increased from 1.6 million in 2013 to 4.3 million in 2018 and 5.1 million in 2022. The stock of doctors, nurses, midwives, dentists and pharmacists was 2.6 million in 2022, representing a threefold increase over 10 years, with an annual growth rate of 13%. The density of these five health workforce occupations grew by 1.9% per annum between 2018 and 2022, from 11.14 per 10 000 in 2013 to 26.82 per 10 000 in 2022. The health professions education capacity in the region increased by 70%, with the annual education output growing from 148 357 graduates in 2018 to over 255 000 in 2022. The comprehensiveness of the findings can be attributed to improvement in health workforce data availability and quality as more countries implement the NHWA. The improvements in the health workforce in the region are also partly attributable to increasing investments in the capacity of health professions education institutions to produce more health workers, and use of evidence in planning, decision-making and high-level advocacy at various levels to invest in health workers.ConclusionThis study provides crucial insights for policy reforms and investments to enhance the health workforce, which is essential to achieving universal health coverage and ensuring health security. While progress is notable, countries with unique challenges need targeted analyses and continuous support to develop the necessary number and skills of health workers in the African region.

Despite improvements in health workforce density, the World Health Organization (WHO) African Region Member States an additional 6.1 million additional health workers by 2030 to achieve universal health coverage (UHC) and health sustainable development goals (SDGs) targets and ensure health security. Additional investments are needed for their education, employment, and retention. However, most countries cannot meet this and require support to secure increased sustainable long-term domestic and external investments in the health workforce to strengthen health systems as part of broader health and national development efforts to improve health, economic, and social outcomes. The Africa Health Workforce Investment Charter, launched by the WHO Africa Regional Office in May 2024, outlines a set of key principles that countries can adapt to stimulate and secure the multisectoral domestic and external investments needed to reduce Africa’s health workforce shortages by 2030. This would ultimately increase access and availability of health care workers and primary healthcare services, especially in rural and underserved communities. The Investment Charter sets out the following key principles for coordinating and sustaining investments in education, employment, retention, and public health functions: (1) Enabling government leadership and stewardship; (2) Applying evidence-informed prioritisation investment; (3) Aligning multisectoral investments through partnership and collaboration; (4) Stimulating more and better investments; and (5) Securing sustainable health workforce investments.Key messageThe African Region has improved its Universal Health Coverage (UHC) index from 24 in 2000 to 48 in 2021 partly through increased investments in the health workforceThe region still faces critical health workforce challenges –requiring investments in at least 6.1 million additional health workers by 2030, while facing a paradoxical unemployment rate of 27% of their trained health workersAt least 43% in additional domestic budget is required to address health workforce unemployment challenges amidst rising debt, escalating workforce out-migration, and unsatisfactory working conditionsReducing health workforce shortages as part of broader multi-sectoral health and national development investment efforts can improve health, economic, and social outcomes. The Africa Health Workforce Investment Charter outlines five principles to help countries secure sustained long-term health workforce investments in the African Region

Background Inadequate access to quality health care services due to weak health systems and recurrent public health emergencies are impediments to the attainment of Universal Health Coverage and health security in Africa. To discuss these challenges and deliberate on plausible solutions, the World Health Organization Regional Office for Africa, in collaboration with the Government of Cabo Verde, convened the second Africa Health Forum in Praia, Cabo Verde on 26–28 March 2019, under the theme Achieving Universal Health Coverage and Health Security: The Africa We Want to See. Methods The Forum was conducted through technical sessions consisting of high-level, moderated panel discussions on specific themes, some of them preceded by keynote addresses. There were booth exhibitions by Member States, World Health Organization and other organizations to facilitate information exchanges. A Communiqué highlighting the recommendations of the Forum was issued during the closing ceremony . More than 750 participants attended. Relevant information from the report of the Forum and notes by the authors were extracted and synthesized into these proceedings. Conclusions The Forum participants agreed that the role of community engagement and participation in the attainment of Universal Health Coverage, health security and ultimately the Sustainable Development Goals cannot be overemphasized. The public sector of Africa alone cannot achieve these three interrelated goals; other partners, such as the private sector, must be engaged. Technological innovations will be a key driver of the attainment of these goals; hence, there is need to harness the comparative advantages that they offer. Attainment of the three goals is also intertwined – achieving one paves the way for achieving the others. Thus, there is need for integrated public health approaches in the planning and implementation of interventions aimed at achieving them. Recommendations To ensure that the recommendations of this Forum are translated into concrete actions in a sustainable manner, we call on African Ministers of Health to ensure their integration into national health sector policies and strategic documents and to provide the necessary leadership required for their implementation. We also call on partners to mainstream these recommendations into their ongoing support to World Health Organization African Member States.

Immunisation is crucial to achieving the Sustainable Development Goals for maternal and child mortality reduction. As Africa marks the 50th anniversary of implementing immunisation programmes, it is imperative to review progress, address challenges and strategise for the future. Using available programme data, this article examines the progress made in achieving the immunisation milestones in the region, describes the success factors and lessons learnt and makes recommendations on how to immunise every African child in the coming years. The article concludes that despite significant improvements in childhood immunisation coverage, the region still falls short of global targets, with disparities across countries. Contributing factors include, among others, weak health systems, rapid population growth without corresponding increases in service delivery, vaccine hesitancy, inadequate sustainable financing and disruptions caused by the COVID-19 pandemic. Moving forward, efforts to attain the global immunisation coverage milestones should focus on building on the past progress, addressing the COVID-19 setbacks, leveraging new technologies and securing sustainable immunisation funding. This can be achieved by accelerating the implementation of the Immunization Agenda 2030 and the Addis Ababa Declaration on Immunization commitments. The support of all stakeholders including political leaders, public health professionals, the vaccine industry, regional organisations, academia, donors and healthcare workers is essential for this noble endeavour.