Integrating Emergency Preparedness Frameworks into Community-Based Reproductive Health Programming in African Countries

Background: Reproductive health services are among the first services to become unstable during epidemics, armed conflict, flooding, drought, displacement, and broader health-system shocks. In African settings, community-based reproductive health programming often depends on community health workers, outreach teams, local referral networks, and decentralized commodity delivery, but emergency preparedness frameworks have historically been designed more visibly around national surveillance, tertiary facilities, and general health security structures than around continuity of local reproductive health access. Objective: This study assessed the extent to which emergency preparedness was integrated into reproductive health continuity arrangements in African countries and examined which operational components were most and least frequently documented in official continuity planning during the COVID-19 period. The analysis also tested whether countries documenting more preparedness actions preserved a broader reproductive health continuity package. Methods: A secondary, multi-country comparative analysis was conducted using the World Health Organization Regional Office for Africa rapid assessment on continuity of essential sexual and reproductive health services. Twenty-four countries with complete continuity-package data were included. Three continuity indicators were coded from country tables, namely family planning, comprehensive abortion care, and post-abortion care. Eleven preparedness-action indicators were coded from the same source, covering triage, infection prevention and control, self-care, multi-month dispensing, supply-chain maintenance, community-based distribution and outreach, guideline revision, coordination, supportive supervision, data monitoring, and explicit facility-level essential-service designation. A continuity score, action index, and composite integration score were calculated. Descriptive statistics, regional comparison, Spearman correlation, and Poisson regression were used. Results: Family planning appeared in 95.8 percent of continuity packages, post-abortion care in 91.7 percent, and comprehensive abortion care in 50.0 percent. The mean continuity score was 2.38 of 3 and the mean preparedness-action score was 2.13 of 11. Guideline revision was the most common action at 41.7 percent, followed by infection-prevention strengthening at 29.2 percent and supply-chain management, coordination, and data monitoring at 25.0 percent each. Community-based distribution and outreach were documented in only 12.5 percent of countries, and multi-month dispensing in 8.3 percent. Uganda had the highest composite integration score, followed by Ghana. South Sudan had the lowest. The action index was positively associated with the continuity score, but the coefficient was imprecise in adjusted models. Conclusion: African countries more commonly protected the policy inclusion of reproductive health services than the decentralized operational mechanisms needed to keep community-based access functioning in crisis conditions. Preparedness integration was therefore partial rather than fully institutionalized. The findings support a shift from emergency response that begins once disruption starts to routine reproductive health programming that is designed from the outset for continuity, decentralization, and recovery.