National Public Health Institutes (NPHIs) are the vehicles for national health security at country level. Success in building robust health systems in Africa requires countries to have well established public health institutions. NPHIs are mandated to ensure population wellbeing and national health security by establishing and maintaining robust public health surveillance and disease intelligence system that detects public health risks and threats early, takes appropriate prevention and mitigation measures, and institute prompt response based on evidence driven data.

There are three types of NPHIs commonly used globally: single autonomous institution, network of institutions, and a department in the Ministry of Health. The latter is less preferable and advised to be used as a start to get in to the first two models of NPHIs. ‘A Network of Institutions is an institution or unit that is established with a legal framework to coordinate public health functions falling under or being conducted by other parastatal institutions at the national level. The network of institutions differs from autonomous/semi-autonomous institutions in that the public health functions for the network of institutions fall into more than one operationally and technically independent institution’ (1). Countries with more than one institution conducting public health functions can follow the second type of NPHI, a network of institutions. This includes countries like South Africa, Kenya, Uganda, and countries with Instituts Pasteur. A country that does not have technically and operationally independent institutions conducting one or more of the core public health functions is more feasible to start establishing a single autonomous institute that coordinates all public health functions under one leadership.

Different NPHIs may be structured in either of the three ways mentioned above. However, all NPHIs should have a role to coordinate and conduct public health research, surveillance and disease intelligence, epidemic preparedness and response, Laboratory systems and networks, and health information system.

Regardless of the type, structure and level of authority of the NPHI, all have similar roles and functions. NPHIs need experienced and committed leader, skilled workforce, infrastructure, funding, continuous assessment, monitoring and support.

NPHIs deliver their responsibilities merely based on data and science with full technical and operational independence under the strategic guidance of the Ministry of Health. To promote research and innovation, ensure sustainability, build public trust, establish strong coordination and partnership, NPHIs should be institutionalized with a legal framework by the country's legislative bodies. Member States that are planning to establish a new NPHI can use the Africa CDC's framework for the development of NPHIs in Africa (2) and Africa CDC's Legal Framework for the institutionalization of new NPHI (3).

There is no competition and overlap of roles between the MOH and NPHIs. The MOH focuses on setting and developing health policies, strategies and programmes, building and capacitating the health care delivery system including the building of hospitals and primary health care units, availing vaccines and therapeutics and regulating the health care service delivery. The role of NPHI is generating and disseminating of scientific information to guide health policy and programmes, providing a coordination platform for public health functions at national level, harmonizes public health assets and information for public health emergency management, provides adequate laboratory infrastructure to perform the essential public health functions efficiently, develops a strong and continuously improving health workforce, provides linkage at international, national and subnational levels to ensure population wellbeing and national health security.

NPHIs increase outbreak detection and emergency response efficiency by bringing similar functions together into one organization and removing redundancy and organizational barriers. By linking key components of public health functions such as surveillance, laboratory capacity, emergency response, communications, and public health research, NPHIs shorten the response time to public health emergency response. In addition, NPHIs also provide focused and centralized leadership and coordination mechanisms for public health.

In countries where there is no functional NPHI, public health functions are fragmented and spread across multiple governmental ministries or sectors. The result often includes duplicated efforts, wastage of resources, lack of accountability and leadership, slower response time to public health emergencies due to uncoordinated efforts, and reduced impact of programmes intended to improve the health of the country's population.

The Africa CDC has identified a need to provide support to strengthen NPHIs in Member States that currently have one and to assist with establishing an NPHI in Member States that currently don't have one. The ultimate thrust is to have fully functional NPHIs in all Member States as part of capacity building and support to the Member States. In both the first (2017-2021) and the second (2023-2027) (4). Africa CDC strategic plans, establishment and strengthening of National Public Health Institute (NPHI) is one of the critical priority programmes of the Africa CDC.

Data generated from Africa CDC desk review assessment revealed that 22 (40%) of the 55 Member States had established NPHIs, 18 (33%) are in the establishment phase and the remaining 15 (27%) Member States have not yet started a process to have one. The assessment also showed that only 18 (82%) of the 22 established NPHIs are fully functional. Central Africa region has the highest proportion (67%) of Member States with no NPHIs; the proportion of Member States with fully established NPHIs in all regions is less than 50%. The data tells that a lot has to be done by Member States, Africa CDC, and partners to make sure that all countries have a fully functional NPHIs in the coming five years. Successful creation of an NPHI requires political buy-in, an experienced and committed national champion that leads the process, a shared vision and plan among critical stakeholders, and sustainable investment. Africa CDC will continue to provide technical support, mobilize resources, and coordinate partners to actualize the NPHI agenda.