Introduction

This document presents a comprehensive compilation of unaltered excerpts from the World Bank’s Assessment of Guinea-Bissau’s Pandemic Prevention, Preparedness, and Response Capacity (2024), an in-depth evaluation of the country’s readiness to address current and future public health threats. The report examines the institutional frameworks, technical capabilities, and operational systems that underpin Guinea-Bissau’s ability to prevent, detect, and respond to outbreaks, while also assessing the resilience of the broader health system. It identifies persistent challenges such as fragmented governance structures, insufficient intersectoral coordination, under-resourced laboratories and surveillance networks, shortages and uneven distribution of health personnel, weak community engagement mechanisms, and a fragile health supply chain.

In addition to documenting these structural and systemic weaknesses, the assessment provides targeted, actionable recommendations for the short, medium, and long term, covering strategic planning, legal and regulatory reforms, workforce development, infrastructure upgrades, and supply chain modernization. The five thematic areas highlighted in this extraction; Governance, Partnership and Coordination; Laboratory and Surveillance; Human Resources for Health; Risk Communication and Community Engagement (RCCE); and Health Supply Chain; are presented exactly as written in the original report, ensuring that the findings and proposed measures are preserved in their authentic form. By focusing on these priority pillars, the document serves as a practical reference for policymakers, technical experts, and development partners seeking to strengthen Guinea-Bissau’s pandemic preparedness and build a more robust, integrated, and sustainable health security framework.

Governance, Coordination, and Partnerships for PPR

Guinea-Bissau was found to have poor coordination, particularly across sectors, and high fragmentation within the health sector for addressing health emergencies. The country lacks strategic plans related to PPR and there is no One Health strategy in place. There is weak financing of important public health institutions, which prevents them from being able to effectively carry out their mandates. Chronic political instability has led to high turnover in leadership roles resulting in the loss of institutional knowledge and a lack of continuity in health programs and initiatives. Additionally, a few leaders are overburdened with multiple appointments in key roles which contribute to delays in decision-making.

Short-term recommendations

1. Conduct a multi-sectoral stakeholder analysis, including the National Institute of Public Health (INASA) and MOH, to identify key players and resource gaps that are most needed for improved PPR coordination and prioritization.
2. Develop a multi-sectoral coordination mechanism (e.g., a convening committee) for PPR that convenes routinely, even in the absence of health crises.
3. Develop a National Response Framework that outlines command structures, roles, and responsibilities of every stakeholder.
4. Develop a costed multi-hazard and multi-sectoral PPR and health emergency plan.
5. Test the Operational Center for Health Emergencies (COES) coordination mechanism and develop relevant guidelines.
6. Document existing legislation related to PPR.

Medium to long-term recommendations

7. Update and develop legal and regulatory frameworks relevant to health emergencies.
8. Develop a One Health national strategic plan and conduct an IHR-PVS National Bridging Workshop.
9. Strengthen the leadership and build capacity of INASA and COES.
10. Develop and implement plans for sustainable financing of INASA and COES operations.

Laboratory Detection and Surveillance Capabilities

Guinea-Bissau’s laboratory detection and surveillance capacity is low and inconsistent across the country. Laboratories lack infrastructure, basic supplies, quality control and proper waste management. Any existing capacity is concentrated in central laboratories leaving regional laboratories, especially in rural areas, with low capacity to detect disease. Animal health laboratories are minimally functioning, and in a state worse off than human health laboratories the critical lack of equipment, testing supplies and trained personnel results in the country being unable to test for any zoonotic diseases for extended periods at a time. No laboratories are accredited in the country, and the specimen referral and transport system is highly unreliable, particularly in rural areas.

Early warning systems are underdeveloped and suffer from a lack of resources at all levels for surveillance of both human and zoonotic diseases. Porous borders with neighboring countries pose a risk for transnational disease transmission yet cross border surveillance is weak. Disease surveillance is largely paper-based with limited use of District Health Information System (DHIS2) software or any other electronic tools. One encouraging aspect is that the community health worker (CHW) program in Guinea-Bissau has the potential to be scaled up to support community-based surveillance (CBS).

Short-term recommendations

1. Conduct a laboratory capacity and surveillance needs assessment followed by asset mapping across sectors (public, private, human, animal) and across the country—including rural areas and points of entry (PoEs)—to identify the most pressing gaps and leverage strengths.
2. Develop a national infectious disease surveillance strategy including priority epidemic diseases and zoonotic diseases, seasonal prevalence of diseases in all regions, guidelines and SOPs for indicator-based surveillance (IBS) and event-based surveillance (EBS).
3. Strengthen community-based surveillance (CBS) by training CHWs in priority disease case definition and contact tracing and by establishing a functional multi-sectoral RRT.
4. Develop a process for and publish routine reports of epidemiological information for priority diseases at the national level.
5. Strengthen the specimen referral and transport system by reviewing existing capacities and needs, developing SOPs and training health care workers (HCWs) and other staff.

Early warning systems are underdeveloped and suffer from a lack of resources at all levels for surveillance of both human and zoonotic diseases. Porous borders with neighboring countries pose a risk for transnational disease transmission yet cross border surveillance is weak. Disease surveillance is largely paper-based with limited use of District Health Information System (DHIS2) software or any other electronic tools. One encouraging aspect is that the community health worker (CHW) program in Guinea-Bissau has the potential to be scaled up to support community-based surveillance (CBS)

Medium to long-term recommendations

6. Strengthen existing IBS and establish EBS for priority diseases.
7. Strengthen laboratory capacity for priority diseases by refurbishing laboratories (including animal health laboratories), training laboratory workers in priority disease diagnostics, and enrolling laboratories in accreditation programs.
8. Build sustainable capacity for a One Health approach to surveillance by coordinating with other relevant ministries/focal points and through joint training and information exchange.
9. INASA, with support from MOH and other key stakeholders, could form a public-private partnership model for the procurement of essential testing supplies and reagents.

Human Resources for Health

Health care workers in Guinea-Bissau are chronically stretched thin and sometimes go without being paid. The human resource situation is worse in rural areas than at the central level. Health care workers often suffer from burnout and lack of training and are given few incentives, including professional opportunities, to stay on the job—this has resulted in significant absenteeism and loss of workforce to other countries (‘brain drain’) that negatively affects service delivery. Mid- and senior-level health staff are frequently replaced with changes in government, leading to a lack of continuity and ineffectiveness of health programs.

Short-term recommendations

1. Elaborate a multi-sectoral workforce strategy to develop human capital across the human and animal health sectors to enhance PPR.
2. Identify required training needs for IHR and institute cascade training (train-the-trainer) programs and hands-on training for detection and surveillance of priority epidemic-prone and zoonotic diseases, risk communication, contact tracing, and infection prevention and control.
3. Establish a three-month basic FETP-V joint training program based on a One Health curriculum and other in-service training programs for HCWs, CHWs, and animal health workers.
4. Appoint personnel within MOH to coordinate and manage health sector training by liaising with external partners and other agencies.

Medium to long-term recommendations

5. Build capacity for animal health staff, laboratory workers, rapid response teams, and strengthen INASA’s capacity for coordination.
6. Develop rural training programs for final-year medical, nursing, and lab technician students for exposure to and to develop interest in practice in rural settings.
7. Strengthen policy reforms and develop programs to boost HRH retention, such as performance-based incentives, differential compensation schemes based on geographic distribution to boost recruitment and retention of rural HCWs, and a service repayment program.

Risk Communication and Community Engagement (RCCE)

The approach to Risk Communication and Community Engagement (RCCE) in Guinea-Bissau has typically been top-down whereby basic risk communication measures are put in place, but no mechanisms exist to collect community feedback on the receptiveness to prevention measures or know whether messages are reaching intended audiences. There is a lack of standard operating procedures for RCCE, which leads to disordered and ineffective risk communications during health emergencies. While a comprehensive National Strategic Plan for Community Health (PENSC) exists, it is in need of support from the government and donors for implementation. CHWs can be a key resource to strengthen disease surveillance at the community level.

Short-term recommendations

1. Identify and map key partners, community influencers, religious leaders, and champions at subnational levels to support community engagement for PPR.
2. Update RCCE strategy and SOPs for RCCE including managing the spread of rumors and misinformation by communicating scientifically validated data via political and technical leaders.
3. Test the RCCE system by planning and operationalizing simulation exercises (SimEx).
4. Provide support to cost the National Strategic Plan for Community Health (PENSC) 2021-2025 and support its implementation.

Medium to long-term recommendations

5. Strengthen CHW retention and recognition to boost community engagement.
6. Develop and conduct cascade training on RCCE.

Health Supply Chain

The health sector supply chain in Guinea-Bissau is highly fragmented and uncoordinated. The lack of a well-functioning national supply chain, inadequate pharmaceutical policies, and the failure of the national medicine procurement agency to manage the country’s need for medicines have led to stockouts of essential medicines in the country. Similar to issues noted in human resources for health, there is a general lack of trained personnel to manage inventory and distribution, high staff turnover that is particularly pronounced with changes in government, and a lack of financial resources to appropriately address key supply chain needs.

Short-term recommendations

1. Develop a national procurement and deployment plan for health emergencies, which should include the receipt, storage, distribution of necessary medicines and other health supplies.
2. Adopt a single, unified governance structure for the supply chain.
3. Develop and validate national supply chain strategic plans and policies.

Medium to long-term recommendations

4. Enhance the skills, knowledge, and performance of health workers, supply chain managers, and other stakeholders involved in the supply chain.
5. Introduce standardized inventory management, distribution and monitoring systems to strengthen procurement processes.
6. Invest in a comprehensive logistics management information system.