Intra-action review of West African health Organization's response to the COVID-19 pandemic in the Economic Community of West African states (ECOWAS) region, 2020 - 2022.

backgroundThe West African Health Organization (WAHO) coordinated the regional response to COVID-19 across the 15 ECOWAS Member States. The scale and duration of the pandemic exposed structural weaknesses requiring systematic evaluation. This intra-action review (IAR) assessed WAHO’s performance, operational gaps, and lessons learned from 2020 to 2022 to strengthen future regional preparedness and response.

methodsA convergent mixed-methods design was used, integrating a targeted desk review, an online survey of WAHO staff, Member State focal points, and liaison officers, 18 key informant interviews, and data from structured IAR meetings conducted between 2021 and 2022. Quantitative data were analyzed descriptively, while qualitative interviews, document, and IAR outputs underwent thematic analysis. Integration was achieved through triangulation, convergence coding, and joint displays across nine core response domains, including coordination, surveillance, laboratory systems, logistics, digital information systems, risk communication, workforce capacity, and cross-border collaboration.

resultsSixty-six respondents completed the survey (63.5% response rate), and 18 interviews were conducted. The highest-rated domains were coordination, laboratory, vaccination readiness, and cross-border collaboration, while digital information systems scored lowest. Qualitative data highlighted WAHO’s strong political convening role, rapid dissemination of harmonized guidance, effective pooled procurement of diagnostics and PPE, and expansion of laboratory and workforce capacities. However, persistent challenges emerged: fragmented digital reporting systems, variable connectivity, customs-related logistical delays, and uneven access to training across countries. Divergence was observed between quantitative and qualitative data for risk communication—survey scores were moderate, but interviews revealed widespread infodemic pressure. Integrated findings demonstratestrong convergence between quantitative and qualitative data for coordination, laboratory systems, and cross-border collaboration, while systemic gaps particularly in digital systems and logistics, limited operational efficiency.

conclusionWAHO played a critical role in coordinating the ECOWAS COVID-19 response, particularly in strengthening regional coordination, laboratory capacity,and cross-border public health functions. Persistent weaknesses in digital surveillance systems, last-mile logistics, and equitable access to training highlight areas requiring sustained investment. Overall,the findings align with broader regional and global evaluations, underscoring the essential role of strong regional institutions in advancing effective and resilient health security in West Africa. Institutionalizing routine IAR/AAR processes, clarifying mandates, and strengthening digital infrastructure and workforce systems are key priorities for enhancing preparedness for future public health emergencies.