Research Article

Assessing Health Security in West Africa: A critical analysis through the lens of the Global Health Security Index and Joint External Evaluations of the IHR 2005

Abstract

Background: The 2014–2016 Ebola epidemic exposed profound health security vulnerabilities across West Africa, yet nearly a decade later, the region’s preparedness capacities remain inadequately characterized. This study provides a comprehensive assessment of health security across the fifteen members states of the Economic Community of West African States (ECOWAS) using the complementary frameworks of the Global Health Security (GHS) Index and the World Health Organization’s Joint External Evaluation (JEE) process. Methods: We analyzed 2021 GHS Index data for all ECOWAS member states, synthesized findings from first and second round JEE reports (2016–2025), and examined compliance indicators including National Action Plan for Health Security (NAPHS) development, costing, domestic financing, and functional capacities such as Emergency Operations Centres (EOCs) and Field Epidemiology Training Programs (FETPs). Comparative alignment analysis was conducted for selected countries to assess convergence and divergence between the two frameworks. Findings: The ECOWAS region recorded the lowest average GHS Index score globally (26.5/100), well below the global average (38.9) and the African average (29.0). Prevention (22.3) and health systems (24.5) were the weakest domains. While all 15 countries completed at least one JEE and six have conducted second rounds, demonstrating an average improvement of +0.8 points on the 1–5 scale, only 20% of countries have costed and funded NAPHS, and just 13% have established domestic health security budget lines. Alignment between GHS Index and JEE was high in four countries (Ghana, Liberia, Sierra Leone, Niger) but moderate in Nigeria and Guinea, revealing complementary blind spots: the GHS Index underestimates laboratory capacity and political commitment, while the JEE may miss systemic structural weaknesses. Encouragingly, between 2015 and 2025, countries with completed JEEs increased from 2 to 12, functional EOCs from 3 to 9, and FETP coverage from 4 to 11. However, heavy reliance on external financing persists, with only five countries having domestic health security budget lines. Interpretation: West Africa has built the planning architecture of health security—JEEs, NAPHS, EOCs, FETPs—but lacks the financed, functional, and resilient systems required for effective epidemic preparedness. The GHS Index and JEE serve genuinely complementary roles and should be used iteratively: the former for global benchmarking and advocacy, the latter for contextual, actionable roadmaps. Without a fundamental shift from donor-dependent projects to domestically sustained systems, and from national silos to regional mutual accountability, the region remains highly vulnerable to the next major  epidemic.  Recommendations: ECOWAS national governments should establish domestic health security financing mechanisms, complete costed NAPHS, functionalize EOCs, and integrate One Health surveillance systems. Regional bodies should operationalize the Regional Centre for Surveillance and Disease Control (RCSDC), create a rapid response fund, and mandate cross-border data sharing. International partners must shift from project-based to systems-based financing, support second JEE rounds for all countries, and invest in digital surveillance and laboratory networks.