West Africa faces recurring public health outbreaks, including Ebola, COVID-19, and Mpox, underscoring the need for strong Global Health Security (GHS) core capacities. This study uses Joint External Evaluation (JEE) scores and After-Action Review (AAR) findings to assess public health emergency preparedness across 15 West African countries and identify gaps between theoretical assessments and operational response capacity. A mixed-methods approach compared JEE scores (2016–2023) with thematic analysis of AAR findings from major outbreaks. Consistency between JEE-predicted capacities and AAR-reported challenges was assessed using a three-level rating system (High/Moderate/Low) and the Kappa statistic. In 68 of 105 technical area comparisons (65%) of cases, JEE scores accurately predicted weaknesses in laboratory systems and workforce development. However, in 37 comparisons (35%) of cases, JEE scores overestimated preparedness, particularly in risk communication(all15 countries,100%), real-time surveillance(13 of 15 countries, 87%), and cross-border coordination, where countries with high scores faced operational failures during outbreaks. AARs revealed logistical bottlenecks, supply chain disruptions, and coordination failures not captured by JEEs. Alignment with SDG 3.d (health security), SDG 10 (inequalities), SDG 17 (partnerships), and SDG 9 (infrastructure) underscores broader development implications. While JEE is valuable for baseline assessment, it incompletely predicts real-world outbreak response performance. Integrating AAR findings into national planning and refining JEE indicators to include operational metrics will enhance health security evaluations. Regionally coordinated action through WAHO is essential for addressing gaps and building resilient systems aligned with sustainable development goals. • JEE scores predict only 65% of real-world outbreak response gaps. • Risk communication and cross-border coordination are often overestimated. • AARs reveal operational bottlenecks missed by JEE assessments. • Fragile states face disproportionate health security capacity gaps. • Regional solidarity mechanisms critical for SDG 3.d achievement.
Bukola et al. (2026) studied this question.