Published in PLOS One on 2026-09-25, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Stephen T Odonkor
Source: PLOS One • DOI 10.1371/journal.pone.0357814
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Sub-Saharan Africa (SSA) faces recurrent threats from re-emerging infectious diseases, including Ebola virus disease, cholera, measles, Lassa fever, and Marburg virus disease. This study assessed the resilience of health systems in 25 SSA countries from 2000 to 2023 using a multidimensional resilience index and a first-order Markov state-transition framework. Country-year observations were classified as Low Resilience, Moderate Resilience, or High Resilience based on epidemiological performance, health financing, surveillance, response capacity, and recovery indicators. Resilience was heterogeneous and path-dependent. Low-Resilience observations had an 82.4% probability of remaining in that state in the subsequent year and only a 3.1% probability of moving directly to High Resilience. Moderate-Resilience observations had a 19.1% probability of transitioning to High Resilience and an 18.2% probability of declining to Low Resilience. High-Resilience observations had a 63.6% probability of remaining High Resilience, but a combined 36.4% probability of regression. Multinomial logistic regression showed that health expenditure per capita, domestic health-financing share, and GDP per capita were positively associated with High Resilience, whereas internal armed conflict was negatively associated with High Resilience. Southern and Eastern Africa showed stronger resilience profiles than Western and Central Africa, while Central Africa had the greatest concentration of Low-Resilience countries. These findings indicate that resilience is dynamic, unevenly distributed, and strongly shaped by sustained financing, economic capacity, and political stability. Policy priorities include strengthening domestic health financing, targeting Moderate-Resilience countries for accelerated improvement, supporting conflict-affected systems, and harmonising regional surveillance and emergency-response mechanisms.
1. Introduction
Infectious diseases remain a major threat to global health security, particularly in low- and middle-income settings where constrained health-system capacity and socioeconomic vulnerabilities can amplify their effects. Sub-Saharan Africa (SSA) continues to experience a high burden of endemic infectious diseases alongside recurrent epidemics of re-emerging infectious diseases (REIDs). Re-emerging infectious diseases are infections that had previously declined or been brought under relative control but have subsequently increased in incidence, severity, or geographical distribution. Important examples in SSA include measles, cholera, yellow fever, Lassa fever, Ebola virus disease, and Marburg virus disease [1–3]. The 2014–2016 Ebola epidemic in West Africa demonstrated that infectious disease outbreaks can have consequences extending beyond population health to affect national economies, social stability, and regional security [3].
The re-emergence and spread of infectious diseases in SSA are driven by interconnected environmental, demographic, socioeconomic, and health-system factors. Climate variability, environmental degradation, land-use changes, and increased human–animal interaction can alter the distribution of disease vectors and increase the risk of zoonotic transmission. At the same time, rapid population growth, unplanned urbanization, population displacement, porous national borders, political instability, and deterioration of health infrastructure can facilitate disease transmission and complicate outbreak control [4]. Weak surveillance and reporting systems, fragmented health financing, shortages of trained health personnel, and sustained underinvestment in public-health infrastructure further limit the capacity of countries to detect and contain outbreaks at an early stage [5,6]. Evidence from Nigeria, for example, has shown that weaknesses in epidemic reporting and surveillance can delay the communication of outbreak information and undermine timely public-health action [6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Stephen T Odonkor. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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