Develop an investment case for NPHIs — Individual consultation

• Background

National Public Health Institutes (NPHIs) are critical to ensuring national health security, particularly during public health emergencies. They provide essential coordination and are instrumental in fulfilling obligations under the International Health Regulations (IHR). In Africa, the lack of robust NPHIs in several countries undermines the continent’s ability to manage public health threats effectively. The absence of these institutions limits preparedness and response capabilities, exacerbating the risks posed by both infectious diseases and emerging health challenges such as non-communicable diseases (NCDs) and mental health concerns.

Since 2017, the Africa Centres for Disease Control and Prevention (Africa CDC) has played a key role in supporting the establishment and strengthening of NPHIs across the continent. In 2018, only 25% of African Union (AU) member states had functioning NPHIs; by 2024, this number increased to 45%, with an additional 35% in the process of establishing them. Despite this progress, 20% of AU member states still lack NPHIs, with the greatest gaps observed in Central Africa, where only three NPHIs exist.

The Africa CDC Strategic Plan for 2023-2027, prioritizes strengthening public health institutions and systems to enhance the continent’s ability to prevent, detect, and respond to public health threats. The plan recognizes the ongoing burden of infectious diseases and the rising impact of NCDs, injuries, and mental health issues, underscoring the importance of a robust, integrated public health system.

The African Union’s Agenda 2063 further underscores health as a central pillar for achieving a prosperous and sustainable Africa, with specific goals to eradicate communicable diseases, reduce the burden of NCDs, and improve overall health outcomes. In this context, NPHIs are not only vital for immediate health security but also for achieving long-term health objectives, including those outlined in the Sustainable Development Goals (SDGs) and the IHR.

An investment case is essential to mobilize resources for strengthening NPHIs, particularly as the continent faces increasing demands for health funding from various stakeholders. This document will outline the rationale for investment in NPHIs, estimating the financing gaps and the economic burden of public health emergencies in Africa. It will also showcase the benefits of investing in NPHIs through case studies from across the continent, demonstrating the positive impact of NPHI development in enhancing public health emergency response and overall health system resilience.

The investment case for NPHIs is critical for improving Africa’s preparedness and response to public health emergencies. By consolidating key public health functions, improving cross-sector collaboration, and leveraging science-based decision-making, NPHIs have the potential to significantly improve public health outcomes and ensure more effective use of resources. This methodology aims to provide a comprehensive analysis of the costs, benefits, and real-world impacts of NPHIs, ultimately supporting efforts to enhance public health systems across Africa.

The primary aim of this investment case is to inform policy and financing decisions on how best to strengthen and sustain core public health functions across African Union Member States. Rather than presupposing a single institutional model, the analysis will assess alternative approaches for delivering these functions, including networked institutional arrangements, and embedded systems within Ministries of Health or other government entities. For credibility with Ministries of Finance and development partners, the investment case will explicitly define: (i) the functional intervention package (i.e., the set of core public health functions being strengthened), (ii) the counterfactual scenarios (including maintaining current systems and incremental improvements), and (iii) the decision metrics (e.g., cost–benefit ratio, return on investment, net present value), including key assumptions and time horizons..

This consultancy is financed under the Africa CDC Support Program to Combat Current and Future Public Health Threats Project (P178633). The assignment contributes to strengthening institutional capacity, sustainable financing, and public health emergency preparedness across African Union Member States, in alignment with the project’s objectives.

• Objective

The main objective of this consultancy is to develop an investment case for strengthening core public health functions across AU Member States by assessing the costs, benefits, and financing needs of alternative institutional and system-level arrangements for delivering these functions. The analysis will quantify:

• the costs of delivering core public health functions across different institutional models and maturity levels;

• the economic and fiscal losses associated with delayed detection and response to public health threats; and

• the avoided losses and efficiency gains attributable to strengthened public health functions under different implementation scenarios..

The analysis will adopt a phased and incremental approach, recognizing that functionality is treated as a continuum rather than a binary state, with countries progressing across different levels of system maturity.

Specific Objectives:

• To assess current financing of core public health functions across AU Member States, regardless of institutional arrangements

• To estimate the economic and fiscal costs associated with delayed detection and response to public health threats

• To quantify the economic and fiscal benefits of strengthening core public health functions

• To develop phased and scenario-based approaches for strengthening public health functions across different levels of system maturity

• To calculate key economic indicators (e.g., NPV, IRR, cost-benefit ratios) under alternative scenarios

• To identify financing gaps and propose sustainable financing strategies aligned with domestic budget systems.

• Scope of Work

The consultant will describe the prons and cons of structuring Public Health Functions in either a single semi-autonomous scientific institution, network of institutions, or as a Department within a Ministry of Health for efficient and effective coordination for public health emergencies. Moreover, the consultant will describe the investment required for the establishment and full operationalization of a NPHI.

The assignment will include the following components:

• Inception and Analytical Framework

The Consultant will prepare an inception report defining the analytical framework of the investment case. This will include:

• Definition of the NPHI maturity level for core Public Health Functions (Surveillance, Emergency Preparedness and Response, Laboratory Networks, Public Health Research, Workforce Development, Health Promotion) in alignment with existing continental and international standards (NPHI Development Framework, NPHI maturity assessment tool, IANPHI Staged Development Tool, etc…);

• Specification of the economic methodology to be applied (e.g., cost–benefit analysis, return on investment, fiscal impact assessment);

• Identification of the diseases and public health emergencies to be included;

• Definition of key assumptions, time horizon, and discount rates.

This phase will ensure clarity, feasibility, and methodological rigor before proceeding to full analysis.

• Definition and Costing of a Functional NPHI Package

The assignment will:

• Estimate the capital and recurrent costs required to deliver tiered functional packages distinguishing minimum core capacities and more advanced capabilities across different institutional arrangements and levels of system maturity, including strengthening existing systems and, where relevant, establishing new institutional structures.;

• Distinguish one-time investment costs from annual operational expenditures.

• Where feasible, propose scalable costing scenarios reflecting different institutional maturity levels (Basic, Developing, Advance, Leading).

• Assessment of Current Financing and Financing Gaps

• Assess current domestic and external financing allocated to NPHIs or equivalent public health functions.

• Analyze the composition and sustainability of these financing streams.

• Estimate financing gaps relative to the cost of a functional NPHI package.

• The analysis will examine how financing for core public health functions is currently distributed across sectors (e.g., health, agriculture, environment, emergency response) and assess opportunities to improve alignment with national budget processes, including medium-term expenditure frameworks and ongoing health financing reforms.

• Economic Burden of Public Health Emergencies

The assessment will include, where data allow:

• Direct health-care costs;

• Government emergency response expenditures;

• Productivity losses;

• Broader economic disruptions.

• Scenario-Based Economic Analysis

The Consultant will conduct a comparative analysis between the four levels of NPHI maturities (Basic level, Developing, Advanced, and Leading)

This analysis will:

• Estimate potential economic and fiscal benefits associated with improved timeliness of detection and response.

• Quantify wastage/duplication of resources avoided/minimized as a result of the centralized coordination established through the NPHI where feasible.

• Present results using decision-relevant indicators such as benefit–cost ratios, return on investment, and indicative fiscal impact estimates.

• Include sensitivity analysis to test the robustness of assumptions.

• The economic analysis will explicitly address methodological challenges, including attribution of outcomes to specific public health functions, treatment of uncertainty, and the integration of epidemiological and economic modeling assumptions. Sensitivity