From continental strategy to country implementation: a document-based scorecard for assessing health security and sovereignty readiness in Africa

Abstract

BACKGROUND: The Africa Health Security and Sovereignty (AHSS) Agenda of the Africa Centres for Disease Control and Prevention (Africa CDC) provides a continental framework for strengthening health security and sovereignty. As implementation begins, no document-based readiness assessment instrument exists to monitor progress against AHSS pillars and goals, limiting efforts to identify bottlenecks and target assistance. OBJECTIVE(S): To develop and apply a document-based scorecard for assessing policy readiness for AHSS implementation across selected African countries. METHODS: We conducted a qualitative policy analysis using systematic document review, deductive framework development, structured coding, and scorecard synthesis. The corpus comprised 48 documents: the AHSS Agenda, the African Union Roadmap to 2030, WHO AFRO guidance, and national policies from 12 named African countries in 5 regional economic community zones. A 10-dimension scorecard based on AHSS pillars and WHO building blocks was applied on a 3-level scale. A second author recoded the corpus independently; materials are openly deposited. RESULTS: Readiness was most consistently reflected in governance and strategic planning and least in financing specificity, digital health architecture, and laboratory and pharmaceutical systems. AHSS-relevant provisions appeared in 3 of 12 financing strategies, 3 of 10 pharmaceutical policies, and 2 of 12 plans, indicating strategic intent but weak operational readiness across the 10 dimensions. CONCLUSIONS: The AHSS/WHO document-based scorecard is a feasible and replicable instrument for monitoring readiness. It identifies governance and implementation gaps and helps Africa CDC, WHO AFRO, governments, and partners target technical assistance. Periodic application would strengthen implementation monitoring, cross-setting comparison, and accountability.