How effective are international deployments in strengthening low- and middle-income countries (LMICs) to respond to outbreaks in the long term?

TL;DR

International health teams help countries handle outbreaks better in the long run when they work closely with local leaders and adapt to local needs.

Contribution

This study provides evidence that international deployments can have lasting impacts on outbreak response systems in LMICs.

Findings

Deployments strengthened systems, infrastructure use, and stakeholder confidence in outbreak response.

Timely, supported, and adaptive deployments were more likely to create long-term impacts.

Country-led and context-aware deployments fostered national ownership and institutional memory.

Abstract

International public health deployments are frequently used to support outbreak response, but there is limited evidence of their long-term impact on national response systems. This study assessed the extent to which deployments contribute to long-term, sustained impacts on the national outbreak response capacities of African Union Member States.

We used an exploratory sequential mixed-methods design for this study. We conducted 83 key informant interviews across ten countries, carried out two in-depth country case studies and administered an online survey among 304 stakeholders involved in international deployments from 28 African Union Member States. Qualitative data were analysed thematically. Adjusted ORs (aORs) and 95% CIs identified factors associated with perceived long-term, sustained impact of deployments using multivariable logistic regression.

International deployments contributed to long-term impacts in national outbreak response across three domains: (1) strengthened systems and protocols; (2) continued use of infrastructure and equipment introduced during deployments and (3) enhanced confidence, knowledge and leadership among national stakeholders. Case studies further illustrated how adaptive, context-aware, collaborative deployments fostered national ownership and institutional memory. Deployments that were timely (aOR 4.4, CI 1.3 to 15.2), supported by deploying agencies (aOR 9.1, CI 2.1 to 39.9) and involved flexible and adaptive deployees (aOR 12.1, CI 1.9 to 77.1) were more likely to make substantial impact on national outbreak response.

International deployments contribute to the sustained impact of outbreak response, particularly when they are country-led and align with local priorities. The findings suggest that international deployments should be viewed not only as emergency surge mechanisms, but also as strategic opportunities for contributing to longer-term impacts on national systems. Future deployment models should prioritise developing soft skills of deployees, ensure deployments are timely, context-appropriate and supported with additional resources to maximise their enduring value.

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