Strengthening emergency response in hard-to-reach settings through mobile Public Health Emergency Operation Centre

Introduction: In many African countries, the effectiveness of outbreak response is hampered by the limited reach of Public Health Emergency Operations Centers (PHEOCs), which are often centralized and inaccessible to remote or underserved populations. This “last-mile coordination gap” contributes to delayed decision-making, inadequate resource mobilization, and increased morbidity during public health emergencies. To address this, we introduce the concept of a mobile PHEOC, a portable, field-deployable unit designed to replicate core PHEOC functions at the subnational and remote settings. Methods: This conceptual paper is based on a structured literature review, comparative analysis of global and regional emergency coordination models, and synthesis of outbreak response experiences in Africa. Technical features and operational functions were adapted from the World Health Organization (WHO) PHEOC framework for resource-constrained environments. Results: Evidence from 29 sources confirms that while 80% of African countries have established PHEOCs, only 29% are fully functional. National centers are often bureaucratic, infrastructure-intensive, and geographically distant from outbreak sites. Decentralized initiatives such as Nigeria’s subnational PHEOCs (which reduced outbreak response time from 10 to 3 days) and Africa CDC’s Incident Management Support Teams in the DRC (supporting deployment of 265,000 mpox vaccine doses), demonstrate the value of field-based coordination. Building on these models, the mobile PHEOC design integrates portable infrastructure (tents, solar-powered ICT), lean command structures based on Incident Management System (IMS), offline-capable digital tools, and codified governance frameworks to extend strategic coordination directly to outbreak sites. This model offers significant operational advantages by facilitating timely data-driven decisions, enhancing coordination between local and national levels, and strengthening community engagement during public health emergencies. Conclusion: The mobile PHEOC is a portable, rapidly deployable system designed to improve emergency response in Africa’s rural and fragile settings by bridging coordination gaps between central command and frontline teams. It enhances timeliness, equity, and data-driven decision-making while engaging communities and local health actors. However, challenges such as sustained funding, equipment maintenance, security in fragile settings, and integration with national health systems must be addressed. To maximize its effectiveness, mobile PHEOCs should be institutionalised within national frameworks, supported by a costed funding plan, interoperable digital systems, and rosters of trained personnel. Evaluation and pilot studies are needed to refine and scale the model for diverse public health threats.