Scoping review

The purpose of this protocol is to conduct a scoping review of the literature on pandemic preparedness, looking at literature from across the African continent. This is to inform a later situational assessment focused on how HTA-related capacities could be developed within existing institutional structures in Nigeria. The scoping review approach [21] was selected because it strives to provide an overview of the many types of evidence in the area of interest and identify the gaps that require further research. The review will be informed by recently published work on COVID-19 health system preparedness in Africa [22]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [23, 24] will be followed in reporting this review to map evidence on the topic and identify main concepts, theories, sources, and knowledge gaps.

The scoping review will adhere to the following procedures:

1. Determining the research questions

2. Identifying the relevant research articles

3. Selection of eligible articles

4. Analyzing the gathered data

5. Compiling and summarizing the results.

(i). Identifying the research questions

The main research questions are

Who are the stakeholders involved in pandemic preparedness and response; What are their roles and contributions to emergency preparedness and response in Africa?

What are the policies, strategies, action plans, strengthened systems, and operational readiness in place to ensure timely deployment and use of evidence to support priority setting following the identification of a potential epidemic or pandemic in Africa?

What are the existing governance/coordination structures and decision-making processes for the control of pandemics in Africa?

In terms of evidence evaluation and priority setting, what are the best practices and areas for improvement in pandemic preparedness and response in Africa?

What is the national, and regional capacity to support data/evidence sharing within and between African countries and the international community?

Inclusion criteria

In order for studies to be considered, they must satisfy the following requirements:

Published, preprint, or grey literature in the English language of full reviews, qualitative, quantitative, or mixed-methods design studies published between 2010–2024 that explore:

Exclusion criteria

Studies with the following attributes will be omitted:

Articles that do not include Africa or the African country experience

Articles focused solely on the biological and clinical aspects of the disease

Articles focused on building manufacturing capacity on the continent in relation to, for example, developing medical countermeasures

(ii). Identifying relevant studies

Study sources

Peer-reviewed and grey literature sources will be used to identify relevant studies. Electronic databases will be used, for example, PubMed, Web of Science, Embase, Scopus, and Google Scholar lists of included peer-reviewed articles will be used as sources of peer-reviewed literature. These databases contain extensive abstracts and citations from a wide range of academic publications, including conference proceedings, books, and scientific journals. The databases also have a rich research output in the field of medicine and health sciences, as well as a flexible search engine for retrieving articles.

A comprehensive search will be conducted to locate both published and unpublished (grey) material on the specified topic, stakeholders, and components of pandemic preparedness and response (PPR) in Africa within the priority setting and resource allocation processes. The relevant, peer-reviewed publications and pertinent grey literature will be looked up in the electronic databases using focused web searches utilizing the key terms. When the full text of the articles is not available, then they will be excluded and added as reasons for exclusion. Study protocols will also not be included in the reviews.

Search strategy

The search strategy will involve the identification of keywords from the research questions that comprehensively cover the topic of interest. The keywords will be tabulated, and their respective variations captured/specified. We will use keywords to capture all articles published on Health Technology Assessment (HTA) to support future pandemic preparedness. In addition, we will extend this search to identify relevant articles across Africa using additional keywords such as priority setting, evidence, and decision-making. Based on these keywords, search strings will be developed for scientific databases. The search strings for the scientific literature will be customized based on the requirements of each database considered in this study (Appendix 1). Table 1 shows the keywords and some variations of the keywords for the search.

Table 1 Keywords for the search

The search method will be tested to see if the databases and keywords are adequate and sensitive enough to identify relevant articles. Based on the outcomes of the test searches, the search string will be modified to improve its suitability in collecting relevant literature. The electronic database search will be documented in a table.

(iii). Selection of eligible studies

The review will cover from 2010 to 2024. We chose 2010 as the beginning because going beyond this year is unlikely to provide relevant evidence for the present context. The eligible articles will be selected after screening the titles and abstracts for eligibility. The complete text will then be reviewed using the inclusion and exclusion criteria. The incorporation of papers that fulfill the requirement for eligibility will assist in addressing the research questions.

Articles from our searches will be uploaded to the Covidence software, which will be used for removing duplicates, title and abstract screening, and full-text reading. A check for the number of duplicate articles Covidence removed will be done by clicking on the Import Studies button at the top of the review. After deduplication, articles will undergo a screening process for inclusion, and this will be conducted by a minimum of two independent researchers, who will evaluate the titles and abstracts. Full-text reading of articles and policy documents will also be done independently by the researchers to confirm inclusion in the review. Any disagreements on eligibility between researchers will be resolved by discussion or consensus. The researchers will make efforts to obtain the complete texts of the chosen publications, either by online searches or by reaching out to all the authors of the study if required. All suitable articles will be uploaded to the Covidence software, where any duplicates will be discovered and then eliminated. The Fig. 1 below shows the PRISMA flowchart for eligible studies that will be included in the review.

Fig. 1

PRISMA flowchart. Adapted from [22]

(iv) Data extraction

The data will be extracted with the use of a data extraction template which will be developed by the researchers. The template will be created in MS Excel and will include information from the article or policy document such as author names, year of publication, title, goal, and relevant content that answers the research questions. The data that will be extracted will consist of the following fields (see Appendix 3).

(v) Collating, summarizing, and reporting the results

We will use a thematic content analysis using narrative descriptions of the extracted data, around the following: country of study, types of stakeholders involved in pandemic preparedness and response; Their duties and contributions in the context of emergency preparedness and response. The various policies, strategies, and action plans aimed at ensuring timely deployment and use of evidence to support priority setting following a potential pandemic in Africa will be covered. Governance and coordination structures, as well as decision-making processes for pandemic control in Africa, including the use of HTA and other evidence-based processes, will be reported. Best practices, constraints, and opportunities for improvement will be identified. Appendix 4 shows the template for the narrative report. The data from quantitative studies will be collated and reported as narratives of the findings. Their tables will not be included in this study.

The review findings will be discussed with respect to the research questions and the general goal of the study. Gap analysis will identify certain places, such as countries in SSA, where there are significant deficiencies or shortcomings, with their PPR plans and strategies, capacity needs for PPR, and HTA for priority setting.

The situational analysis will seek to draw on the literature review to develop a rapid assessment of the institutions and institutional processes that could be involved in any future pandemic and outbreak management scenario. This assessment would look at areas of strength and weakness, especially with respect to priority setting and the collection and use of evidence, and identify opportunities for capacity building. The main area to explore is how HTA-like systems could be used to support policy-makers in pandemic scenarios. The situational analysis will be developed based on the recently created International Decision Support Initiative (iDSI) guidance and reporting template [25], and also draw on earlier work by Uzochukwu and colleagues, 2019 [13].