Temporal trends in African healthcare system capacities in prevention, detection, response, and sustainability...

This analysis evaluated self-reported national capacities for prevention, detection, response, and sustainability in 54 African countries from 2013 to 2023 using data from WHO State Party Annual Report (SPAR) submissions. Countries were grouped into five UN-defined regions. Global averages were used as external benchmarks. Four capacity domains were scored using SPAR indicators. Regional and temporal differences were analyzed using ANOVA with Tukey's multiple comparisons. Time trends from 2010 to 2023 were assessed using linear regression. Pre- and post-COVID-19 changes were compared using 2018 and 2023 data. Global scores were consistently higher than African regional means across all capacities. In 2023, African preventive capacity was 63.88 globally and 52.66 (p < 0.0001). Northern Africa scored highest within Africa (67.22), while Middle Sub-Saharan Africa remained lowest (34.07; p = 0.0134 vs Northern). Detection capacity in Africa rose from 56.67 (2013) to 63.12 (2023), still trailing the global score of 72.21 (p = 0.0001). Response capacity increased sharply in Africa in the post-pandemic period, from 38.48 in 2018 to 59.86 in 2023 (p = 0.0014), led by Northern Africa (73.75). Sustainability scores improved modestly in Africa (46.28 in 2018 to 54.78 in 2023; p = 0.0006), with Middle Sub-Saharan Africa lowest at 43.81. Full-period regression analysis revealed significant negative trends in prevention capacity for Africa overall and several subregions and positive trends in detection capacity for Northern, Middle, and Western Africa. Sensitivity analyses restricted to 2018-2023 revealed prevention trends reversed to positive; response and sustainability gains were concentrated in the post-pandemic period. Between 2013 and 2023, African regions showed incremental gains across all capacity domains, with the largest post-pandemic improvement in response capacity. However, persistent performance gaps remain, especially in Middle Sub-Saharan Africa. The data support targeted investment in infrastructure, workforce, and diagnostics to close gaps and stabilize long-term health system performance.