The REDISSE Benin project (Regional Disease Surveillance Systems Enhancement) is a national project whose implementing structures (IS) are the Ministry of Health (MoH), the Ministry of Agriculture, Livestock and Fisheries (MALF) and the Ministry of Living Environment and Sustainable Development (MLESD). The project aims to strengthen national and regional intersectoral capacities for collaborative disease surveillance and epidemic preparedness in West Africa, by overcoming weaknesses in human and animal health systems that hamper effective disease surveillance and response, and, in the event of an emergency, to provide an effective immediate response.

The project comprises five (05) components: (C1) Surveillance and health information. (C2) Laboratory capacity building. (C3) Emergency preparedness and response. (C4) Human resources management for effective disease surveillance and epidemic preparedness. (C5) Institutional Capacity Building, Project Management, Coordination and Advocacy.

Benin was embarked on phase 3 of the project, which began in 2018. With the advent of the COVID-19 pandemic, the project underwent a number of readjustments to cope with it, the last of which was the additional funding of December 2022 that came into effect in February 2023 in order to achieve all the unmet indicators and strengthen the veterinary health mandate over the remaining duration of the project, the closing date of which was March 31, 2024.

Now that it has come to an end, it has become important to document its implementation, in order to draw out the results and lessons learned and share them with all stakeholders, with a view to improving preparedness and response policies and practices throughout the ECOWAS region. It is with this in mind that the present study has been initiated to capitalize on the achievements and document the best practices of the REDISSE project in Benin.

This was a descriptive cross-sectional study involving the main stakeholders in ISs that were recruited on an exhaustive way. As recommended in the literature [1] [2] , the best way to identify lessons learned and good practices is to reflect with the various stakeholders using participatory methods. In addition to semi-structured individual interviews, we mainly organized thematic workshops by component, to identify and validate lessons learned, good practices and propose improvement mechanisms to be taken into account by the sector.

Discussions were conducted in groups, bringing together experts in animal and human health. The environmental health experts were divided among the groups thus formed. For each theme, three groups were set up, two for human health and one for animal health. Work was organized starting with a session to clarify the concepts of capitalization, lessons learned, best practices and SWOT (strengths, weaknesses, opportunities and threats) analysis, community participation and empowerment.

A lesson learned is a mechanism for documenting learning and sharing it with others [1] [2] . It is an essential contribution to knowledge building based on what worked and what didn’t. It should describe what to do or avoid in similar projects. It should describe steps to be taken or avoided in similar projects. Lessons learned are an essential contribution to good practice, which is often a concise way of presenting specific information from the knowledge base. A good practice is a successful experience that has been tested and reproduced in different contexts, and can therefore be recommended as a model. It deserves to be shared so that more people can adapt and adopt it.

The groups proceeded to analyze strengths and weaknesses, opportunities and threats (SWOT), specify good practices and propose guidelines for the improvement of acquired knowledge/good practices. The tools used for the group work are presented in Table 1 .

The items of each criterion were scored 1 and 0 according to whether they were present or not. To be validated, each criterion had to combine at least 75% of the score assigned to it. The criterion was classified as “strong” if the total of the scores combined was at least 75%, and as “weak” if the total of the scores combined was less than 75%. The “strengths” selected were examined in the light of the good practice criteria, which are: i) proven and successful, ii) environmentally, economically, socially and temporally sustainable, iii) gender-sensitive, iv) technically feasible, v) the result of a participatory process, vi) replicable and adaptable. Box 1 defines each of the criteria for characterizing good practice. To be considered a “good practice”, the “strengths” had to meet all the criteria, otherwise it is classified as a “lesson learned”.

Box 1. Good practice characterization grid.

Once the best practices had been identified, a summary table was drawn up to provide an overview and suggest possible areas for improvement ( Table 2 ).

Table 2. Summary of good practice characterization.

In plenary sessions, presentations included a SWOT analysis of the project in the sector, the identification of good practices in the sector and, on the basis of the proposed analysis grid, the characterization of these good practices. At the same time, the groups proposed guidelines for the improvement/consolidation of best practices. Discussions occur after each group presentation to ensure all the criteria have been taken into account for the validation of best practices and lessons learned.

By “management” we mean prevention, preparedness, response and rehabilitation (of public health emergencies).

The data collected, essentially qualitative, was subjected to a content analysis based on the criteria set up as presented in Box 1 and cross-checked by triangulation with the individual semi-structured interview results in order to bring out the major ideas emerging from each working group and meeting the mission’s objectives. Common elements to the various technical components were identified, thereby refining the number of best practices.

Semi-structured individual interviews were conducted with a number of players chosen on the basis of their roles in the project, and who were not involved in the thematic workshops.

Thematic workshops procedure

The thematic workshops took place from January 30 to February 2, 2024, devoting a full day to each theme. Generally starting at 9am, the workshops ended at 5pm local time. Group work lasted between 2 and 3 hours 30 minutes, depending on the theme.

A total 54 (Surveillance workshop), 47 (Preparedness & response workshop), 53 (Human Resources workshop), 26 (Laboratories workshop) participated to the thematic workshops, and five semi-structured interviews. Tables 3 - 5 and Table 6 show the profile and number of participants per thematic workshop. The interviewees were the Procurement Specialist (PS) and the Administrative and Financial Manager (AFM) within the project, followed by three participants, departmental authorities, present at the thematic workshops.

Local authorities, mainly prefectures, are involved in the monitoring process.

Table 4. Breakdown of participants by sector and region—Preparedness & response workshop.

Local authorities, mainly prefectures, are involved in the preparation and response process.

Table 5. Breakdown of participants by sector and region—Human Resources workshop.

Local authorities, mainly prefectures, are involved in the human resources management process as part of epidemic management.

Table 6. Breakdown of participants by sector and region—Laboratories workshop.

Best practices

Table 7 presents the various best practices by theme.

Table 7. Summary of best practices.

Acronyms: APCOs: Animal Products Control Officer; AWPs: Annual Work Plan; CHO: Community Health Officer; CSSAZD: Computerized Surveillance System for Animal and Zoonotic Diseases; DEP: Disease with Epidemic Potential; FETP: Field Epidemiology Training Program; IDSR: integrated disease services and response; IPC: Infection Prevention and Control; ISAVET: In Service Applied Veterinary Epidemiology training; LD: Livestock Division; NAD: Notifiable Animal Disease; NCHP: National Community Health Policy; PPVs: Para Professional Veterinarian; RRTs: Rapid Response Teams; SH: Sexual Harassment; SEA: Sexual Exploitation and Abuse; SOPs: Standard Operational Procedures; VSs: Veterinary Services; ZD: Zoonotic disease.

Lessons learned

Box 2 presents the various lessons learned by animal and human sector.

Box 2. Lessons learned.

The good practices and lessons learned have been the subject, depending on the case, of proposals for improvement or conditions necessary for their maintenance.

The systematic attention paid to public health emergencies and the understanding of the need to manage resources and information are now major achieve ments following the events experienced in the region and worldwide in recent years. In view of the results of this capitalization exercise, we would like to highlight a number of elements, following the example of Wise [3] . The imple mentation of a rapid and rigorous evaluation process is necessary to ensure continuous quality improvement. Leadership is the essential ingredient for successful coordination as was the case with REDISSE Benin project at the time of the COVID-19 pandemic. The public health response varies according to events, so leadership must be flexible. REDISSE showed this leadership flexibility in the situation of the rabies epidemic with innovative strategies to quickly respond to it. Command and control must be agile to adapt to changing circumstances within and between public health emergency events. Authorities must be decisive yet flexible. They must also: i) know public health practices (they were trained during the COVID-19 pandemic), ii) be able to maintain good situational awareness, iii) provide continuous situation assessment to the population, iv) inspire confidence, v) coordinate the various members of the response team and vi) lead and manage effective and timely communications [4] .

This exercise is also important in the various stages of epidemic management, and more specifically in preparing to respond to public health emergencies.

The importance of capitalizing on and sharing best practices

By capitalizing on and sharing best practices, a team, organization, or country can learn from its own experiences and those of others. This provides an opportunity to transform knowledge into action and build capacity to improve results, and to respond more quickly and effectively to different types of crisis or change that may arise [1] . If no steps are taken to analyze, capitalize on and share the knowledge acquired in programs and projects, mistakes are likely to be repeated, successful experiences may be forgotten and opportunities to improve practices lost. More specifically, we will recall the value of this exercise in improving: public health emergency preparedness, the capacities of professionals involved in public health emergency preparedness, the roles of authorities in improving public health emergency preparedness, community preparedness for public health emergencies.

Improving preparedness for public health emergencies

Capitalizing on and sharing best practices highlights areas where preparedness could be improved. In the case in point, REDISSE’s experience identifies the following concerns regarding the country’s response to the COVID-19 pandemic: i) insufficient resources—securing additional funding to meet all unmet indicators and strengthen the veterinary health mandate over the remaining duration of the project; ii) inequitable access to health care—which led the project to set in motion a process to reinforce staffing, taking into account the specific needs of the communities; iii) inconsistent messages—the project invested in building the capacity of actors in risk communication and community engagement (RCCE) to ensure that interactions with communities took place in strict compliance with the principles of community engagement with a view to adopting measures to cut the chain of transmission.

Improving the skills of professionals involved in public health emergency preparedness

Capitalizing on and sharing best practices will help improve the various activities of professionals in relation to emergency preparedness and population health promotion [5] : epidemiological surveillance, data collection on health risks, community involvement in action on the social determinants of health, the establishment of community partnerships and partnerships with other non-health sectors, in particular animal health in this case, for the continuous improvement of living conditions in communities, developing health policies and plans that help individuals and communities prevent and manage disease and risk factors, ensuring compliance with health regulations, promoting accessibility to human and animal health care, training providers and first responders in public health emergencies.

Enhancing the role of authorities in improving public health emergency preparedness

Authorities have specific roles to play in public health emergency prepared ness, which can be enhanced by capitalizing on and sharing best practices. These include: encouraging emergency planning, providing emergency training, fostering teamwork and multi-sectoral preparedness, raising awareness among community members [6] .

Improving community preparedness for public health emergencies

Communities can prepare for public health emergencies, such as epidemics and natural disasters, through a combination of planning, training and education [5] . Effective preparation for public health emergencies can pay dividends, strengthening community response when a crisis occurs and aiding recovery afterwards. Through effective planning, training and education, public health officials and community members can help keep people safe and enable them to get the help they need immediately. Capitalizing on and sharing best practices are resources that can help to reinforce achievements and facilitate an effective response [5] .

Other lessons learned

Other lessons learned from this capitalization include: i) the establishment of a command and control organizational structure prior to the event; ii) the pre-positioning of a disaster assessment team; iii) the designation of a single point of contact for the coordination of activities; iv) the implementation of a disaster clause for local employees or at national level to reallocate personnel to fill support gaps should the need arise; v) pre-positioning RCCE systems; vi) identifying external sources to fill common resource gaps; vii) developing a plan to support government operations; viii) pre-organizing support contracts for needed resources; ix) acquiring uninterrupted power supply; and x) collaborating with industry to receive commitments to restore critical services after a disaster. This coordination plan requires a dominant and directive leadership style to be successful, and capitalization is an asset in this case, providing proven elements to take into account [3] [7] .

The effects of a pandemic generate similar response needs. Coordination is essential to deal successfully with pandemics. Decentralized public health agencies need to coordinate better and establish a command and control plan. Surveillance capacities must be strengthened to ensure that the scale of pandemics does not take the country by surprise. Coordination between private, public and government agencies needs to be formalized. Adequate and appropriate resources, including human resources, must be planned and funded for the long term. Consistent command and control arrangements are needed, along with a firm commitment from political leaders to maintain preparedness over time. Participative yet decisive and flexible coordination leadership is essential, given the lessons learned from the COVID-19 pandemic. An important complement to this response is community engagement, which is included in the coordination effort to cope with the effects of pandemics. Community preparedness, response and recovery capacity can help optimize pandemic contingency planning. These are all aspects that capitalization can bring to the table, so as to benefit greatly and avoid inventing the wheel [7] [8] .

It is therefore important to relate the broad outlines of this capitalization to the disaster risk reduction model developed by the United Nations, which aims to harmonize policies worldwide in this field—the Sendai Framework. The aim of the Sendai Framework is to reduce loss of life, injury, health impact and the effect of social determinants of health. The main priorities of the Sendai Framework are: i) understanding disaster risk, ii) strengthening disaster risk governance, iii) investing in disaster risk reduction and iv) improving disaster preparedness [6] [7] [9] .

The richness of a project lies not only in the immediate achievement of its results, but also and above all, in its usefulness for similar interventions, whether in the local, regional, national or international context. It is in this context that the REDISSE project has set out to make public the various lessons learned and best practices from the implementation of its activities over a period of some five consecutive years.

The methodology used, which is the one recommended in the literature, the thematic workshops, brought together the main players to discuss the strengths, weaknesses, opportunities and threats of the interventions carried out. As a result of the group work and plenary discussions, the lessons learned and good practices summarized in this paper were identified.

Many of the lessons learned are good practices, given their internationalization through the WHO’s International Health Regulations (IHR) [10] and the World Organization for Animal Health (WOAH) codes [11] , and therefore deserve to be taken into consideration for future projects, so as to avoid perpetual repetition, but rather in a process that builds on the evidence to move towards innovative results for greater impact on populations.