The role of economic evaluation in public health emergency management of disease outbreaks in Africa: a qualitative research.

BACKGROUND

Recurrent disease outbreaks impose severe health and economic burdens on Africa, exposing critical gaps in public health emergency management (PHEM). Despite growing recognition of its value, economic evaluation (EE) remains largely absent from PHEM practice on the continent. This study aims to explore the role of EE in public health emergency management and assess its potential to strengthen health security in Africa, with a focus on the Africa Centres for Disease Control and Prevention (Africa CDC).

METHODS

A qualitative research design was employed, using in-person Key Informant Interviews (KIIs) with 12 purposively selected Africa CDC division heads and senior technical advisors between 15 March and 15 April 2023. Thematic analysis was conducted following the framework of Braun and Clarke (2006), with themes derived inductively from the interview data. A logic modelling framework was applied as a complementary tool to visualise EE's causal chain across the four PHEM phases. Supplementary review of Africa CDC strategic documents, policy frameworks, and programme guidelines was undertaken to contextualise and triangulate the findings.

RESULTS

Four themes emerged inductively from the analysis. First, key informants unanimously recognised EE as a critical but underutilised tool across the full PHEM cycle. Second, participants identified a concrete EE research agenda including return-on-investment analyses for preparedness, cost-effectiveness of diagnostic infrastructure, and health budget compliance monitoring. Third, significant barriers to EE integration were identified - principally a shortage of trained health economists, limited financial resources, and inadequate familiarity with health economics among decision-makers - alongside strategic opportunities presented by Africa CDC's institutional positioning. Fourth, key informants framed EE as both a technical decision-support tool and a political communication instrument for influencing high-level policymakers.

CONCLUSIONS

Mainstreaming EE into PHEM - through investment in health economics capacity, standardised methodologies, and institutionalised evidence use - can optimise the allocation of limited resources across preparedness, response, and recovery. Africa CDC is strategically positioned to lead this agenda continentally.