Benin: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Benin has a national AMR plan for the surveillance, detection, and reporting of priority AMR pathogens. The National Multisectoral Action Plan against Antimicrobial Resistance (AMR) for the period 2019–2024 has been officially adopted and is aligned with the World Health Organization (WHO) Global Action Plan. The plan includes a particular focus on AMR surveillance and research, with the aim of establishing a national surveillance system and reference laboratory, as well as designated laboratories for detecting priority resistant pathogens. The plan also aims to harmonise the collection, analysis and sharing of data relating to human, animal and plant health. Nevertheless, the plan does not include a timeline for implementation. ¹² However, a recent assessment (2025) in the Journal of Public Health in Africa, titled "Overview of antimicrobial resistance mitigation efforts," shows, in the section Results – Discussion, that surveillance remains fragmented in practice, with only around 23% of the plan's activities having been implemented. The entire study demonstrates that data collection remains largely ad hoc and often limited to certain laboratories, with no standardised, continuous national system in place. ³

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 0

There is no evidence that Benin has an officially functioning national reference laboratory dedicated to antimicrobial resistance. Such information is not provided on the Ministry of Health website ⁴, in the National Health Development Plan (NHDP) for 2018-2022 ⁵, in the National Health Security Plan (NHSP) for 2019-2021 ⁶, or on the World Health Organization (WHO) website ⁷. A recent assessment titled "Strengthening clinical bacteriology laboratory diagnostics to combat sepsis and antimicrobial resistance in Benin: a train-the-trainer approach" (2024) emphasises, in its "Introduction" section, the absence of an equipped and operational reference laboratory, as well as the impossibility of establishing a fully structured national laboratory network for this purpose. ⁸ Current initiatives as "Strengthening clinical bacteriology laboratory diagnostics to combat sepsis and antimicrobial resistance in Benin: a train-the-trainer approach" (2024) and "Closing the GAP in Antimicrobial Resistance Policy in Benin and Burkina Faso" (2022) primarily rely on ad hoc studies conducted by university or hospital laboratories, particularly the Regional Institute of Public Health (IRSP) in Ouidah and the University of Abomey-Calavi, rather than establishing an official, standardised detection network. ⁹¹⁰

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence to suggest that the Government of Benin currently conducts formal, nationwide surveillance of the environment to detect antimicrobial residues or resistant organisms (AMR) in soil or waterways. This information is not provided on the Ministry of Health website ¹¹, in the National Health Development Plans (NHDPs) for 2018–2022 ¹², in the National Health Security Plan (NHSP) for 2019–2021 ¹³, or on the World Health Organization (WHO) website ¹⁴. No formal government programmes have been identified for this purpose. While Benin's National AMR Action Plan (2019–2024) does mention the objective of strengthening environmental surveillance, no regular or structured field activities have yet been implemented ¹⁵¹⁶. However, independent scientific studies, such as "Assessment of the Bacterial Pollution and Detection of Antibiotic Resistance Genes in Benin: Case of the Hydrographic Channel Complex Cotonou-Nokoué Lake" (2021), in the sections "Abstract" and "Introduction", have revealed significant contamination of surface water, sediments and hospital effluents in Benin. This includes the presence of resistance genes (bla_(TEM), sulI, sulII, bla_(SHV), bla_(OXA)) in water, sediment and fish samples around Lake Nokoué and its canals ¹⁷. While these analyses demonstrate that environmental antimicrobial resistance (amino acids and genes) is documented by academic or research initiatives, no structured government policy or system yet exists to systematically monitor the environment for antimicrobials or AMR ¹⁸.

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is national legislation that requires a medical prescription for the use of antibiotics on humans. Although Beninese legislation imposes mandatory prescriptions for human antibiotics, their effective implementation is often insufficient, with regular illegal dispensing occurring. In Benin, a prescription is required to purchase most antibiotics intended for human use. This requirement is governed by Law No. 97-025 on the Control of Drugs and Precursors, which strictly regulates the prescription and dispensing of medications, including antibiotics. Article 52 requires that Schedule II and III medications (including most antibiotics for human use) may only be dispensed by licensed pharmacists with a valid prescription signed by an authorised healthcare professional. Article 53 defines the formal requirements for a prescription, such as the identification of the prescriber and patient, dosage and duration, and signature, and prohibits the dispensing of any non-compliant prescription. According to Article 57, prescriptions for Schedule II drugs must be recorded in official stub books issued by the relevant professional body and in accordance with a regulatory model. ¹⁹ However, subsequent studies by The Global Health Network entitled "Dispensing of Antibiotics Without Prescription in Southern Benin, West Africa, 2018" (2023) and by the Scientifc Research Publishing titled "Antimicrobial Stewardship: Knowledge and Attitudes of Pharmacy Staff on Antibiotic Disppensing Patterns, Use and Resistance in Benin" (2023) confirmed that dispensing without a prescription was common, particularly in pharmacies and informal markets, despite the legal ban. ²⁰²¹

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 100

In Benin, the use of antibiotics in veterinary medicine is regulated by law and there is no evidence of gaps in enforcement. Decree No. 2014-352, dated 2 June 2014, establishes the veterinary medicinal product regime in Benin. ²² Title V, Chapter II of the Decree deals with the retail distribution of veterinary medicinal products, including antibiotics (see Article 2). ²³ Article 33 stipulates that the retail dispensing of certain veterinary medicinal products, particularly those posing risks to animals, users, or consumers of animal products (especially antibiotics), must be preceded by a prescription from a veterinarian. ²⁴ The prescription must be given to the end user for products that require a prescription. Article 34 requires detailed records to be kept for each dispensing, including the identity of the prescriber. ²⁵

1.2.1a Laws/plans on zoonotic disease

Score: 100

In Benin, there is a national strategic framework in place for prioritising, detecting and reporting these diseases. A 2001 ministerial decree RESUREP (no. 080/MDR/DCAB/SGM/DA/CP of 6 February 2001) established a national network for the epidemiological surveillance of animal diseases, prioritising epizootics and enabling rapid detection across the country. ²⁶²⁷ The National Action Plan for Health Security of Benin 2019–2021, published by the Ministry of Health, sets out plans to develop and implement an integrated national surveillance programme for major zoonotic diseases. This programme includes mechanisms for detection, prioritisation, and intersectoral reporting (human, animal, and environmental health). The plan also provides for the establishment of a multisectoral platform to coordinate human and animal surveillance units, facilitate data sharing between public and veterinary laboratories, and deliver "One Health" programme training to stakeholders. ²⁸ Joint assessments using the World Health Organization (WHO) IHR States Parties Self-Assessment Annual Reporting (SPAR) tool and the World Organisation for Animal Health (WOAH) Veterinary Services Performance Evaluation Process (VSP) tool confirm that Benin has frameworks for surveillance of zoonotic diseases, but that these remain partially effective. ²⁹³⁰ There is no evidence that Benin publishes regular (weekly or monthly) epidemiological bulletins on zoonoses. Targeted initiatives do exist, however, for example: scientific surveillance against dengue fever; sentinel surveillance of COVID-19 as part of the STREESCO project; epidemiology training via the CDC. These elements show that surveillance capabilities are in place, but there is no evidence of regular national bulletins for the public, in line with the 2019-2021 plan. ³¹³²

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

There is no evidence of any national legislation, plan or strategic directive that has been clearly published and explicitly includes measures to identify and reduce the risk of zoonotic diseases being transmitted from animals to humans. This information is not provided on the Ministry of Health website ³³, in the National Multisectoral Action Plan against Antimicrobial Resistance 2019–2024 ³⁴, the National Health Development Plans (NHDPs) for 2018–2022 ³⁵ and the National Health Security Plan (NHSP) for 2019–2021 ³⁶. World Health Organization's 2017 Joint External Evaluation (JEE) report indicates that there are preparedness and response plans in place for certain priority zoonoses, such as highly pathogenic avian influenza, anthrax and rabies. However, no document mentions specific measures to reduce the risk of transmission to humans or to monitor animal-human interfaces. ³⁷ The 2014 Veterinary Services System Gap Analysis by the World Organisation for Animal Health (WOAH), through Chapter III "Strengthening animal health skills" (p41-51) and Chapter IV "Skills enhancement for veterinary laboratories" (p51-55), highlights insufficient regulatory and technical capacities to effectively identify or control the risk of zoonotic spread, and the absence of a formal national regulatory framework dedicated to this purpose. ³⁸ Furthermore, the World Health Organization's 2020 States Parties Self-Assessment Annual Reporting Tool (SPAR) assessment gave Benin a score of 20% for its capacity to address zoonotic events and the human-animal interface. ³⁹ This indicates weak multisectoral coordination and mobilisation for zoonotic diseases and the absence of a national legal framework dedicated to identifying or reducing the risk of transmission from animals to humans. However, the 2024 SPAR assessment reports a capacity to address zoonotic events and the human-animal interface (indicator C3) of 50%. Sub-indicator C3.1, which measures multisectoral collaborative effort on zoonoses, scored 60%. These scores represent a significant improvement on those in 2020, indicating progress in intersectoral coordination and response to zoonoses in Benin. ⁴⁰⁴¹ The 2024 SPAR assessment shows that the country now has a partial framework for the detection and management of zoonoses, involving more sustained collaboration between the human health, animal health, and environmental sectors.

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

In Benin, national strategic documents address the surveillance and control of several zoonotic agents of public health concern. In June 2021, Benin held a national workshop to prioritize zoonoses using the One Health Zoonotic Disease Prioritization (OHZDP) tool. The assessment "Prioritizing zoonotic diseases using a multisectoral, One Health approach for The Economic Community of West African States (ECOWAS)" (2021), section "Results", shows that this multisectoral process resulted in the establishment of an official list of six priority zoonoses, including avian influenza, rabies, hemorrhagic fevers (Ebola, Lassa, Crimean-Congo), anthrax, acute respiratory syndromes (including COVID-19), and trypanosomiasis. ⁴²⁴³ This work is part of Benin's National Health Security Action Plan 2019-2021 (NHSAP), developed using the One Health approach that considers human, animal, and environmental aspects. ⁴⁴ The plan provides for integrated detection, reporting, and response to priority zoonoses through coordinated mechanisms. Furthermore, the international principles of the One Health Joint Plan of Action, developed by the FAO, the World Organisation for Animal Health and the World Health Organization, reinforce these national priorities. ⁴⁵⁴⁶ No publicly accessible document details the specific SOPs or institutional mechanisms for reporting and coordinating zoonoses within the NHSAP 2019–2021. Instead, recommendations and overarching governance frameworks exist, alongside regional precedents in practice. ⁴⁷

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is no evidence of a department, agency or similar unit functioning as a dedicated, multisectoral coordination mechanism for zoonotic diseases across all ministries. This information is not provided on the Ministry of Health website ⁴⁸, on the Ministry of Agriculture website ⁴⁹, in the National Multisectoral Action Plan against Antimicrobial Resistance 2019–2024 ⁵⁰, the National Health Development Plan (NHDPs) for 2018–2022 ⁵¹ and the National Health Security Plan (NHSP) for 2019–2021 ⁵². In practice, coordination is ensured by the National Health Crisis and Emergency Committee, which is led by the Ministry of Health and comprises various ministries (human health, agriculture, environment, etc.). This committee takes a 'One Health' approach to managing health crises, including zoonoses. However, it is not explicitly mentioned as an organisation responsible for managing zoonoses. While zoonoses are part of its remit, no public description confirms that it is specifically responsible for them. ⁵³⁵⁴ Furthermore, external initiatives such as FAO-ECTAD and USAID support the structuring of veterinary surveillance and multisectoral training in Benin ⁵⁵⁵⁶. However, these efforts are carried out through projects rather than by a permanent body enshrined in national legislation. According to USAID, Breakthrough Action "Report: Mapping of the stakeholders of the Benin one health platform" (2024), (pp. 4-5), the national animal disease surveillance network (RESUREP), which was established by ministerial decree (no. 080/MDR/DCAB/SGM/DA/CP of 6 February 2001) in 2001, remains focused on animal health without formally extending to include the coordination of human health and environmental issues ⁵⁷⁵⁸.

1.2.1e Presence of One Health strategic plan

Score: 0

Benin does not have a One Health strategic plan in place, according to the 2017 Joint External Evaluation (JEE) report.⁵⁹ However, the country has a National Multisectoral AMR Action Plan (2019–2024) that incorporates One Health principles, particularly for antimicrobial resistance (AMR).⁶⁰

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

In Benin, a voluntary national mechanism enables livestock owners to conduct and report disease surveillance to a central government agency. Although Decree No. 2005-637 of 13 October 2005 establishes the animal health protocol for notifiable animal diseases in Benin, it does not explicitly state in a specific article that owners are obliged to personally report suspected or confirmed diseases ⁶¹. However, it provides a general definition of notifiable diseases and specifies the relevant authorities. Article 2 lists the notifiable animal diseases and specifies that their presence or suspicion must be reported to the relevant veterinary authority immediately ⁶². Article 1, points 2 and 3, defines the veterinary administration as 'the government service with jurisdiction throughout the country to implement animal health and international certification measures' and specifies that the veterinary authority is the veterinary service under the veterinary administration that is directly responsible for applying animal health measures in a given territory ⁶³. In the absence of an article specifying the owner's direct role in notification, it can be inferred that any keeper or veterinarian is responsible for transmitting information to the veterinary authority. No formal procedures are described in a separate article ⁶⁴. The Decree requires the immediate notification of cases of notifiable diseases to the veterinary authority but does not directly assign individual responsibility for notification to the owner. This obligation falls more broadly on the keeper or stakeholders involved on a voluntary basis, through the surveillance chain structured by the veterinary administration. Olivier Mahuton Zannou, Head of the Epidemiological Surveillance Division at Benin's Livestock Department, has been designated as the national focal point for animal disease notification within the OIE. This designation means that disease reports must be centralised and transmitted via this division. ⁶⁵ A study published, entitled "Capacity Building Efforts for Rabies Diagnosis in Resource-Limited Countries in Sub-Saharan Africa: A Case Report of the Central Veterinary Laboratory in Benin (Parakou)" (2022), details the implementation of rabies diagnostic capabilities at the Laboratoire Vétérinaire Central (LADISERO) in Parakou. Prior to 2018, confirmation was based solely on clinical observations. This development demonstrates that confirmatory tests and structured surveillance can now be carried out in practice (sections Abstract and Introduction). ⁶⁶ According to an FAO page on animal health information, veterinary services should publish periodic bulletins on notifiable diseases at appropriate intervals, as well as annual reports. However, my research found no recent public publication of weekly or monthly animal surveillance bulletins for Benin. ⁶⁷

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no public evidence of legislation or regulations protecting the confidentiality of information generated by animal monitoring activities for owners. This information is not provided in Decree No. 2005-637 of 13 October 2005 (establishing zoosanitary regulations for notifiable animal diseases in the Republic of Benin) ⁶⁸, the Ministry of Health website ⁶⁹, on the Ministry of Agriculture website ⁷⁰, in the National Multisectoral Action Plan against Antimicrobial Resistance 2019–2024 ⁷¹ and the National Health Security Plan (NHSP) for 2019–2021 ⁷². However, Law No. 2017-20 of 20 April 2018 on the Digital Code ⁷³ and Law No. 2009-09 of 22 May 2009 ⁷⁴ on the protection of personal data, govern the protection of personal data, including that collected during health monitoring programmes. These laws set out the following fundamental principles: legality; purpose; security; and minimisation of personal data. When personal data (breeder contact details or farm locations) is used, it must be processed in accordance with these standards under the supervision of the National Data Protection Commission (NDPC) ⁷⁵⁷⁶⁷⁷. Although Benin does not have a legal system dedicated to the confidentiality of veterinary epidemiological data, any personal information collected in this context is protected by national legislation governing the collection, processing, purpose, access, and security of data. Breeder contact details or farm locations collected in surveillance programmes fall under this protection. While the laws do not directly mention 'health monitoring' or 'animal health data', such information qualifies as personal data by definition if it can identify individuals.

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Benin conducts surveillance of zoonotic disease in wildlife (wild animals, insects, other disease vectors), poultry and livestock.

Between 2006 and 2008, systematic active surveillance was implemented in several West African countries, including Benin, targeting backyard chickens, guinea fowl, ducks and pigs. PCR and serological analyses revealed no evidence of infection or influenza-specific antibodies in these populations. ⁷⁸ Between 2010 and 2014, a study entitled "Avian influenza surveillance in Central and West Africa, 2010–2014" (2014) was conducted in Benin to collect samples (cloaca and throat swabs) from wild birds, as well as environmental samples, as part of avian influenza surveillance. The study was funded by the U.S. National Institute of Allergy and Infectious Diseases and the National Institutes of Health, Department of Health and Human Services ("Acknowledgements" section). ⁷⁹

In 2019, through a project run by the Food and Agriculture Organization of the United Nations (FAO) (TCP/BEN/3702), the government has strengthened veterinary capacities, reactivated a participatory surveillance network, and improved detection in veterinary laboratories.⁸⁰ In June 2021, the country identified six priority zoonotic diseases (avian influenza, rabies, hemorrhagic fevers, anthrax, COVID-19, and trypanosomiasis) during a multi-stakeholder workshop using the One Health Zoonotic Disease Prioritization tool (OHZDP).⁸¹ The country has a formalized epidemiological surveillance network under the direction of the Livestock Directorate (focal point of the World Organization for Animal Health-WOAH), which includes veterinarians dedicated to reporting animal diseases, including in wildlife. ⁸²

Work published in 2022 documents the detection of tick-borne pathogens (such as rickettsiae and bartonella) from cattle in Benin, emphasising the importance of ongoing surveillance of these zoonoses.⁸³ A study by Discover Animals (2025) confirms that animal surveillance networks, including for wildlife, are still in place in Economic Community of West African States (ECOWAS) member states. ⁸⁴ There are often ad hoc or time-limited surveys. While there is a formalized surveillance network in place, there is no evidence of time-limited surveillance, ongoing surveillance of zoonotic diseases in wildlife in Benin.

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Benin officially has a notification mechanism to the World Organisation for Animal Health (WOAH), accessible to the public via the WAHIS system. ⁸⁵

The national focal point for notifications is established within the Beninese veterinary services, thus ensuring the transmission of cases of notifiable animal diseases to the WOAH. These immediate notifications are also published publicly on the WOAH's WAHIS portal ⁸⁶. For example, Benin reported a case of highly pathogenic avian influenza (H5N1) in December 2021, which is accessible in the system's archives. ⁸⁷⁸⁸ The portal presents the most recent notifications for African states (up to 2025). The publication of the H5N1 case in 2021, followed by the absence of new publicly visible notifications between 2024 and 2025, may indicate the absence of new reported alerts, but the channel remains active and available. Benin's participation in national coordination meetings, such as the 2025 review and outlook sessions, demonstrates its active engagement in dialogue with ministries, veterinary services and technical partners. While the official documents do not explicitly outline reporting mechanisms to WOAH, these participatory activities suggest that Benin maintains regular communication and collaboration with WOAH, thereby contributing to the global animal health surveillance network and aligning with WOAH's objectives. ⁸⁹

1.2.4a Number of veterinarians per 100,000 people

Score: 1.99

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 6.89

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no evidence that the national zoonotic disease control plan or any other relevant legislation includes mechanisms for collaborating with the private sector to control or respond to zoonoses. This information is not provided on the Ministry of Health's website ⁹⁰, on the Ministry of Agriculture's website ⁹¹, or in the National Health Development Plans (NHDPs) for 2018–2022 ⁹². The 2017 World Health Organization (WHO) Joint External Evaluation (JEE) ⁹³ report on Benin highlights the need to formalise a partnership with the private sector, particularly with private veterinarians, as an area for improvement. This implies that such a partnership has not yet been established. Moreover, the 2nd Joint External Evaluation (JEE), conducted between 24 and 28 July 2023, states that "the private sector is not involved in assessing preparedness" (p. 45). ⁹⁴ While the 2019-2021 National Health Security Plan does provide for the coordination of health emergencies, it does not include a formal partnership clause with the private sector in the event of a zoonotic disease outbreak. The plan envisages multisectoral coordination. through the National Health Crisis and Emergency Committee (CNCS), which acts as the primary coordination body for health emergencies, including zoonoses. Operating under a One Health framework, this committee brings together multiple ministries. such as as Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries. The plan also envisages technical and operational coordination through working groups and subcommittees for epidemic surveillance, laboratory diagnostics and logistics management. However, none of these subcommittees directly addresses working with the private sector. ⁹⁵ The National Multisectoral Action Plan against Antimicrobial Resistance (AMR) 2019–2024 outlines multisectoral activities, but none of these formally involve the private sector in combating zoonoses. There is no mention of the private sector's contribution. However, some areas (antimicrobial use and animal health surveillance) mention veterinary stakeholders. There is no legal mechanism or systematic framework dedicated to private sector engagement. ⁹⁶ Finally, national initiatives or 'One Health' plans mobilise public stakeholders (the Ministries of Health, Livestock and the Environment), but no legal partnership or official mechanism systematically integrates the private sector into responses to zoonoses. ⁹⁷

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no evidence to confirm the existence of a public registry updated within the last five years concerning facilities in Benin where particularly dangerous pathogens and toxins are stored or processed, including information on inventories and stock management systems. There is no evidence of such a record on the websites of the Ministries of Health ⁹⁸ or Agriculture ⁹⁹. Benin's National Health Security Action Plan (NHSAP / 2019-2021) ¹⁰⁰ also indicates that the registration of dangerous pathogens and toxins is not yet effective in facilities that contain them. The country plans to implement measures to strengthen biological safety and security, including staff training and the development of product use guidelines. The NHSAP emphasises the training of laboratory personnel in both human and animal health laboratories. The plan proposes the creation of standard operating procedures for handling dangerous pathogens and toxins. These procedures cover storage and access controls, as well as the transport of infectious materials and waste management but do not directly address creating a public registry. ¹⁰¹ The 2nd Joint External Evaluation (JEE), conducted between 24 and 28 July 2023, does not contain evidence that Benin has a public registry of facilities where particularly dangerous pathogens are stored or processed. ¹⁰² It is possible that initiatives have been undertaken at the local level or in specific laboratories, but this information is not publicly available. ¹⁰³¹⁰⁴

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no evidence that Benin has biosecurity legislation that addresses certain issues related to physical containment, operational practices, and risk management associated with particularly dangerous pathogens and toxins. However, the issue of cybersecurity in this context is not explicitly addressed. Benin's legislation does not make a difference between biosecurity and biosafety. The Beninese Penal Code, specifically Article 221, defines biological and toxin weapons in accordance with the Biological Weapons Convention (BWC), prohibiting their manufacture, acquisition, and use. ¹⁰⁵ This provision aims to prevent risks associated with dangerous pathogens and toxins. In addition, Benin's Digital Code, defined by Law No. 2020-35 of January 6, 2021, establishes a legal framework for personal data protection and cybersecurity. ¹⁰⁶ Although this code does not specifically address facilities handling pathogens, it imposes security obligations on critical infrastructure, which may include those handling sensitive biosecurity-related data, although this is not specified. The National Biosecurity Council is responsible for defining and implementing safety measures for the use of living modified organisms. These measures include containment protocols and incident response strategies. The country has adopted Decree No. 2023-060 of February 22, 2023, on the protection of critical information infrastructure. ¹⁰⁷ This text requires operators of critical infrastructure, which may but does not explicitly include facilities handling pathogens, to put in place mechanisms for detecting and responding to security incidents. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that, "A comprehensive regulatory framework for biosafety and risk prevention has been put in place" (p9) ¹⁰⁸, but that framework is not publicly available, including on the websites of the Ministry of Health ¹⁰⁹.

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

Thereis no evidence that Benin has an agency (a national council) is responsible for enforcing biosecurity legislation and regulations. Benin's legislation does not make a difference between biosecurity and biosafety. Law No. 2021-01, passed on 3 February 2021, constitutes the primary legal framework for biosafety and biosecurity in Benin. ¹¹⁰ It establishes a structured regulatory regime governing the use of living organisms (biotechnologies and GMOs) but not pathogens. Article 1 establishes the 'Regional Scientific and Technical Biosecurity Committee', which is the West African Economic and Monetary Union's (WAEMU) scientific and technical advisory committee on biosafety ¹¹¹; however, it does not establish a dedicated biosecurity agency. Nevertheless, Decree No. 2025-015, issued on 22 January 2025, establishes a National Biosafety Council responsible for enforcing the relevant legislation. ¹¹² Article 2 defines this council's responsibilities: 'To ensure the application of rules relating to the assessment, management, information and awareness-raising of the risks associated with the development, use, dissemination and transboundary movement of living modified organisms and derived products that are likely to have an adverse effect on the environment, human and animal health and the conservation and sustainable use of biological diversity" ¹¹³ This council "coordinates cooperation efforts between national and international institutions, civil society, and non-governmental organisations working in the field of biotechnology and biosafety in the Republic of Benin." ¹¹⁴ There is no evidence that the National Biosafety Council has a website.

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is insufficient evidence that Benin has taken efforts to consolidate inventories generally or to consolidate stocks of particularly dangerous pathogens and toxins into a limited number of facilities. Benin has ratified the Biological Weapons Convention (BWC), thereby committing itself to preventing the proliferation of dangerous biological agents. ¹¹⁵ In this context, the country has implemented biosecurity and biosafety measures. ¹¹⁶ Despite these initiatives, challenges remain, particularly in terms of effective implementation and coordination between the various stakeholders. Continued efforts are needed to ensure the effectiveness of these measures. Nevertheless, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "a register and inventory of biohazardous agents are kept in facilities where the agents in question are stored or processed" but does not contain evidence that Benin has taken steps to consolidate its stock of particularly dangerous pathogens and toxins (p. 26). ¹¹⁷ A review of the website of the Ministry of Health ¹¹⁸ and the World Health Organization, Africa Region ¹¹⁹, identified insufficient evidence that Benin has taken steps to consolidate stocks of particularly dangerous pathogens or toxins. Although Benin is party to the Biological Weapons Convention (BWC), there is no public evidence that it has submitted Confidence-Building Measures reports to date. ¹²⁰ And the Vertic's BWC Legislation Database also does not show evidence that Benin has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. ¹²¹

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

Public evidence attests to Benin's ability to perform polymerase chain reaction (PCR) diagnostic tests for anthrax and/or Ebola, which would prevent the growth of live pathogens. However, this information is not included on the Ministry of Health's website ¹²² or in the National Health Development Plans (NHDP) for 2018–2022 ¹²³, nor in the National Health Security Plan (NHSP) for 2019–2021 ¹²⁴. While the National Multisectoral Plan for Combating Antibiotic Resistance for 2019–2024 does address surveillance, laboratory capacity and research with the aim of strengthening the capacity of the country's microbiological laboratories, there is no mention of PCR tests for anthrax or Ebola.¹²⁵ Nevertheless, various scientific and press articles as "Assessment of the Biosafety and Biosecurity in the Reference Veterinary Laboratory of Parakou in Benin" (2021), "Africa CDC organizes first training on Real-Time PCR-based Monkeypox virus (MPXV) testing for 20 African Union Member States" (2022) and "Faster Ebola Tests Could Help Stem the Outbreak in West Africa" (2014) indicate that Benin is capable of performing PCR-based diagnostic tests. ^126127128 At the Veterinary Reference Laboratory (LADISERO) in Parakou, biological confirmation of disease caused by Bacillus anthracis is carried out by PCR, demonstrating autonomous diagnostic capacity. ¹²⁹ In the field of human health, the Viral Haemorrhagic Fever Laboratory (LFHB) in Cotonou implemented PCR-based molecular tests in March 2020, primarily for SARS-CoV-2. This facility is authorised to handle haemorrhagic viruses and represents a credible platform for performing Ebola diagnoses by PCR without having to grow the live virus. ¹³⁰

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no public evidence that Benin requires standardized, mandatory training (via a common program or “train-the-trainer”) for all personnel working in facilities handling pathogens, toxins, or particularly dangerous biological materials that could cause a pandemic. No evidence of such training has been found on the websites of the Ministry of Health ¹³¹, the Ministry of Agriculture ¹³², or the Ministry of Higher Education and Scientific Research. ¹³³ Moreover, the main laboratories do not have publicly available websites. Benin has a Regional Institute of Public Health, established in 1977 with World Health Organization (WHO) support to train sufficient numbers of qualified health personnel. It has a website but that website does not offer information about this type of training ¹³⁴. Although the 2017 Joint External Evaluation (JEE) report indicates that government authorities are committed to “providing technical and financial support for the preparation of a national training program for personnel in biosafety and biosecurity for all facilities where dangerous pathogens and toxins are held or handled,” and that “training sessions on biosafety and biosecurity have been organized for laboratory staff, with the support of partners and the West African Network of Biomedical Laboratories" (pp. 1-2). There is no mention of a formal protocol, standardized approach, or train-the-trainer program. ¹³⁵ Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that “update and implement the staff training plan” is “Recommended as priority measures” (p. 33). ¹³⁶ A 2021 study, entitled "Assessment of the Biosafety and Biosecurity in the Reference Veterinary Laboratory of Parakou in Benin" evaluated, in its "Abstract" section, that the biological risk management score was very poor (42%), highlighting the lack of an effective biosafety training program and standardized operating procedures. ¹³⁷

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no public evidence that any regulations or licensing requirements specify that security personnel or other personnel with access to particularly dangerous pathogens, toxins or biological materials that could cause a pandemic are subject to the following screenings: drug testing, background checks and psychological or mental fitness checks. This information is not included in the Beninese Labour Code ¹³⁸, Law No. 2021-01 on Biosecurity ¹³⁹, the Ministry of Health's website ¹⁴⁰ or the National Health Security Plan for 2019–2021 ¹⁴¹. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, does not contain information on this subject. ¹⁴²

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no evidence that Benin has made any national regulations for the safe and secure transport of infectious substances (particularly categories A and B) publicly available. This information is not included in Decree No. 79-109 of 15 May 1979 concerning road transport in the Republic of Benin ¹⁴³, Law No. 2021-01 on biosafety ¹⁴⁴, the Ministry of Health's website ¹⁴⁵ or the National Health Security Plan for 2019–21 ¹⁴⁶. Benin does not appear to have a formal national regulatory framework that covers the transport of infectious substances according to the international classifications of categories A (UN 2814/2900) and B (UN 3373) ¹⁴⁷. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, indicates that there are recommendations for a specimen transport system but that there is a lack of documentation, oversight, standardization, consistency and resources for the system (pp. 32-33). ¹⁴⁸

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no evidence of legislation and/or regulations in place to oversee the cross-border transfer and end-user control of pathogens, toxins, and particularly dangerous pathogens with pandemic potential. This information is not included in Decree No. 79-109 of May 15, 1979, on road transport in the Republic of Benin ¹⁴⁹, in Law No. 2021-01 on biosafety ¹⁵⁰, on the Ministry of Health website ¹⁵¹, or in the National Health Security Plan for 2019-2021 ¹⁵². None of the consulted texts refer to a specific licensing or authorization regime for this type of biological material. The requirements for the secure transport or control of biological agents (UN 3373 and UN 2814/UN 2900) ¹⁵³ are international standards that have not been transposed into a formal legal framework in Benin. The available national texts do not integrate these obligations into domestic law. ^154155156

1.4.1a Biosafety laws/regulations

Score: 0

There is no evidence that Benin has in place national biosafety legislation and/or regulations because Benin's legislation does not make a difference between biosecurity and biosafety. This legal framework is defined by Law No. 2021-01, which was passed on 3 February 2021 and concerns biosecurity in the Republic of Benin. ¹⁵⁷ Adopted to regulate the transfer, handling and use of living modified organisms, the law is consistent with the Cartagena Protocol on biosecurity. ¹⁵⁸ Comprising 98 articles divided into chapters, this text establishes procedures for management, control and risk assessment, as well as liability and compensation in the event of damage. ¹⁵⁹ The law also establishes regulatory bodies such as the National Scientific Committee (Article 1), the scientific and technical committee of the West African Economic and Monetary Union (CEMAC), responsible for biosafety. ¹⁶⁰

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no evidence of an Beninese agency (a national council) that is responsible for enforcing biosafety/biosecurity legislation and regulations. Country's legislation does not make difference between biosecurity and biosafety. Law No. 2021-01, passed on 3 February 2021, now constitutes the primary legal framework.¹⁶¹ It establishes a structured regulatory regime governing the use of living organisms (biotechnologies and GMOs) but not pathogens. Article 1 establishes the 'Regional Scientific and Technical Biosafety Committee', which is the West African Economic and Monetary Union's (WAEMU) scientific and technical advisory committee on biosafety.¹⁶² However, it does not establish a dedicated biosafety agency. Nevertheless, Decree No. 2025-015, issued on 22 January 2025, establishes a National Biosecurity Council responsible for enforcing the relevant legislation.¹⁶³ Article 2 defines its responsibilities: 'To ensure the application of rules relating to the assessment, management, information and awareness-raising of the risks associated with the development, use, dissemination and transboundary movement of living modified organisms and derived products that are likely to have an adverse effect on the environment, human and animal health and the conservation and sustainable use of biological diversity." ; "coordinates cooperation efforts between national and international institutions, civil society, and non-governmental organisations working in the field of biotechnology and biosafety in the Republic of Benin". ¹⁶⁴ There is no publicly available evidence of the council taking any regulatory actions since its establishment. Also, no information is currently available on its meeting frequency. Nevertheless, the decree defines its structure, membership composition, its size. In the Article 3, it's mention that the council is composed with a representative of the Ministry for the Protection of Natural Resources; a representative of the Ministry for Agriculture, Livestock and Fisheries; Benin's focal point under the Cartagena Protocol; a teacher-researcher specializing in biodiversity issues, representing the Ministry for Scientific Research; the director of the national biosafety laboratory; a representative of the Ministry of Health; a representative of consumer associations or NGOs; a representative of the Ministry of Justice; a representative of the Ministry of the Interior; a representative of the Ministry of Trade; a customs inspector representing the Ministry of Finance. ¹⁶⁵

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no public evidence that Benin requires standardized, mandatory biosafety training (via a common program or “train-the-trainer”) for all personnel working in facilities handling pathogens, toxins, or particularly dangerous biological materials that could cause a pandemic. Neither Law No. 2021-01 on 'biosecurity in the Republic of Benin' nor Decree No. 2025-015 on 'the responsibilities, organization and operation of the National Biosecurity Council' contains any information on this matter. ¹⁶⁶¹⁶⁷ No such training has been found on the websites of the Ministry of Health¹⁶⁸, the Ministry of Agriculture¹⁶⁹ and the Ministry of Higher Education and Scientific Research.¹⁷⁰ Moreover, the main laboratories do not have websites. Benin has a Regional Institute of Public Health, established in 1977 with World Health Organization (WHO) support to train sufficient numbers of qualified health personnel, there is a website but there is no current information on a biosafety training. ¹⁷¹ Although the 2017 Joint External Evaluation (JEE) report indicates that government authorities are committed to “providing technical and financial support for the preparation of a national training program for personnel in biosafety and biosecurity for all facilities where dangerous pathogens and toxins are held or handled,” and that “training sessions on biosafety and biosecurity have been organized for laboratory staff, with the support of partners and the West African Network of Biomedical Laboratories,” there is no mention of a formal protocol, standardized approach, or train-the-trainer program (p17). ¹⁷² Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that, "A comprehensive regulatory framework exists for biosafety and risk prevention" (p. 26). ¹⁷³ A 2021 study, entitled "Assessment of the Biosafety and Biosecurity in the Reference Veterinary Laboratory of Parakou in Benin" evaluated, in its "Abstract" section, that the biological risk management score was very poor (42%), highlighting the lack of an effective biosafety training program and standardized operating procedures. ¹⁷⁴

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that the country has conducted an assessment to determine whether research involving especially dangerous pathogens and/or pandemic-potential toxins is ongoing. Neither Law No. 2021-01 on 'biosecurity in the Republic of Benin' nor Decree No. 2025-015 on 'the responsibilities, organization and operation of the National Biosecurity Council' contains any information on this matter. The Ministry of Health website ¹⁷⁵, the Ministry of Higher Education and Scientific Research website ¹⁷⁶ and the World Health Organization (WHO) website ¹⁷⁷ also contain no information on this topic. The National Health Development Plan (NHDP) for 2018–2022 ¹⁷⁸ and the National Health Security Plan (NAPHS) for 2019–2021 ¹⁷⁹ also do not contain any information on this topic. A 2021 study named "Assessment of the Biosafety and Biosecurity in the Reference Veterinary Laboratory of Parakou in Benin", evaluated the biosecurity practices of the Laboratoire de Référence Vétérinaire (LADISERO) in Parakou. The overall score obtained was insufficient (42.4%), revealing significant administrative, technical, and procedural shortcomings in the management of biorisk ¹⁸⁰. The only available information concerns the evaluation of biosecurity protocols in a veterinary laboratory and is therefore not relevant to the surveillance of potentially sensitive research programmes. ¹⁸¹

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no public evidence of legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. Nor do the websites of the Ministry of Health ¹⁸², the Ministry of Higher Education and Scientific Research ¹⁸³, or the World Health Organization (WHO) ¹⁸⁴. Nor do the National Health Development Plan (NHDP) for 2018–2022 ¹⁸⁵, or the National Health Security Plan (NAPHS) for 2019–2021.¹⁸⁶ Law No. 2021-01 of 3 February 2021, on biosecurity, in the article 2 “lays down rules for the protection of the transfer, handling and use of living modified organisms and derived products resulting from modern biotechnology.” ¹⁸⁷ However, it does not cover highly dangerous viral or bacterial pathogens, nor does it mention any oversight mechanism for dual-use or gain-of-function research. Decree No. 2025-015, which establishes the National Biosecurity Council, defines authorisation procedures and risk assessments.¹⁸⁸ No article explicitly provides for a mechanism for monitoring or tracking research projects on pandemic or dual-use agents. There is no specific institutional or regulatory mechanism in Benin that oversees, evaluates or controls these sensitive scientific activities.

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no public evidence of an agency responsible for overseeing research involving especially dangerous pathogens and toxins, or pathogens with pandemic potential. This is also not evident on the websites of the Ministry of Health ¹⁸⁹, the Ministry of Higher Education and Scientific Research ¹⁹⁰, or the World Health Organization (WHO). ¹⁹¹ The same applies to the National Health Development Plan (NHDP) for 2018–2022 ¹⁹² and the National Health Security Plan (NAPHS) for 2019–2021. ¹⁹³ Law No. 2021-01 of 3 February 2021 on biosecurity establishes a Scientific Biosecurity Committee composed of experts (including microbiologists, toxicologists, veterinarians, and lawyers) who are responsible for scientifically evaluating files related to modified living organisms and for providing technical support to the National Biosecurity Council. ¹⁹⁴ Decree No. 2025-015 establishes the National Biosecurity Council and defines authorisation procedures and risk assessments.¹⁹⁵ However, it does not include any provisions for supervising, auditing or monitoring high-risk or dual-use research projects.

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available legislation or regulation requiring synthesised DNA (deoxyribonucleic acid) to be screened against lists of known pathogens and toxins prior to sale. This is no evidence of such a law or regulation on the websites of the Ministry of Health ¹⁹⁶, the Ministry of Higher Education and Scientific Research ¹⁹⁷, or the World Health Organization (WHO) ¹⁹⁸. The same applies to the National Health Development Plan (NHDP) for 2018–2022 ¹⁹⁹ and the National Health Security Plan (NAPHS) for 2019–2021. ²⁰⁰ At a national level, Law 2021-01 on biosecurity in the Republic of Benin only regulates genetically modified organisms and contains no provisions for controlling synthetic DNA sequences. ²⁰¹ Decree 2025-015, which establishes the responsibilities, organisation and operation of the National Biosafety Council, also makes no mention of compulsory screening of synthetic DNA in relation to pathogens or toxins. ²⁰² At an international level, the 2003 Cartagena Protocol on Biosafety concerns the manipulation and transfer of living modified organisms, but does not explicitly cover synthetic DNA ²⁰³. Although Benin is a party to the Protocol, it does not impose screening of synthetic DNA. The WHO "Global Guidance Framework for the Responsible Use of the Life Sciences: Mitigating Biorisks and Governing Dual‑Use Research", (2022) recommends that countries implement control mechanisms for synthetic DNA with the potential to be pathogenic or toxic, particularly via lists of concerning sequences. ²⁰⁴ However, this document is not legally binding and serves only as a technical reference.

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

There is no evidence of official data on foot-and-mouth disease vaccination in Benin is directly accessible to the public via the World Organisation for Animal Health's (WOAH) World Animal Health Information System (WAHIS) database.²⁰⁵ The WAHIS public reporting interface enables Member States to report their FMD status, vaccination campaigns and vaccine usage. However, these data are not complete or publicly available for all countries, and there are no accurate reports on Benin's vaccination volumes in recent reports. ^206207208 Quarterly reports from the WRLFMD reference laboratory do not mention the vaccines used in Benin or the number of doses administered. ²⁰⁹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Benin has implemented an Expanded Program on Immunization (EPI) that includes routine childhood vaccination, which was reinforced during the National Vaccination Conference, and has developed a national action plan to improve vaccination performance. ²¹⁰ Benin has an “equity strategy” integrated into its national EPI, aimed at reaching “zero dose” children and under-vaccinated populations, particularly in the least covered municipalities. ²¹¹²¹² Goals include reducing barriers like geography and misinformation. This is operationalized through USAID’s MOMENTUM project, which offers technical support in four prioritized departments, and through empowered community health workers who conduct outreach and increase awareness. There is no separate standalone equity strategy; equity is pursued through enhancements to the EPI and practical, locally tailored interventions. ²¹³ The national plan includes targeted strategies to overcome geographic and socioeconomic barriers, including proactive identification of low-coverage areas and operational planning to reach forgotten populations. This involves microplanning at the health zone and district levels to identify underserved populations, tailor vaccination sessions, map households and create specific outreach days for remote areas. Furthermore, it involves establishing mobile vaccination teams to serve hard-to-reach communities where fixed health centres cannot maintain coverage. It also involves community mobilisation to increase awareness and reduce refusals, as well as tracing those who have missed appointments and conducting follow-up home visits. There is also an equity focus on children in low-coverage municipalities and poor urban settings. ²¹⁴ Benin has a national vaccination plan structured around its EPI and reinforced by the States General of Vaccination. ²¹⁵

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

Benin is implementing measures to combat vaccine hesitancy and bolster public confidence in its national vaccination programme. Nevertheless there is no publicly evidence of an immunization strategy/plan.

In November 2021, to address vaccine hesitancy in Benin, the government mobilized community leaders, including traditional chiefs, religious figures, teachers, local dignitaries, taxi-motor drivers, public criers, and media personnel, to communicate clear and culturally relevant messages about COVID-19 vaccination. The messages emphasized the safety and effectiveness of vaccines and sought to debunk prevalent myths, such as concerns about side effects, fertility issues, or population control schemes. To address people's doubts, health workers and trusted community figures held sensitization sessions, home visits, and public discussions, providing personalized explanations and sharing their own vaccination experiences. By combining factual reassurance with local influence and visible role models, these strategies helped convince hesitant individuals to get vaccinated, contributing to a rise in coverage of the population ²¹⁶ Benin has a National Immunization Programme, formally referred to as the Programme Élargi de Vaccination (PEV), which is its version of the Expanded Programme on Immunization (EPI) recommended by WHO. From 2022 to 2023, a Communication on Risks and Community Engagement workshop, supported by the World Health Organization (WHO) and USAID, updated national vaccine communication strategies by targeting areas with low demand and adapting messages to local cultural realities. Specific strategies included using traditional communication channels, such as community meetings and local radio broadcasts, to share accurate information about vaccines. The workshop also encouraged the use of local languages and culturally appropriate visuals to improve understanding and acceptance of the messages. These adaptations were designed to ensure that vaccination messages were understood and embraced by the diverse communities of Benin. ²¹⁷²¹⁸ A campaign conducted in collaboration with Meta-Management Sciences for Health disseminated video testimonials targeting young adults, reducing vaccine hesitancy from 50% to 10% and increasing vaccination coverage from 0.16% to 11% between August and December 2021. ²¹⁹

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Benin has a national technical advisory group responsible for guiding the government on its vaccination strategy. It is equivalent to the National Immunization Technical Advisory Group (NITAG). ²²⁰ Nevertheless there is no publicly evidence of an immunization strategy/plan. The assessment named "Scaling-up the development of national immunization technical advisory groups in the Economic Community of West African States: role of a regional organisation, the West African Health Organisation" (2014) explained that Benin created its NITAG with the support of the West African Health Organization (WAHO) and the SIVAC program (Strengthening Immunization and Vaccination Advice in Countries) to provide national decision-makers with scientific recommendations based on available data. ²²¹ In the assessment entitled "Strengthening National immunization technical advisory groups (NITAGs)", researchers developed an advisory recommendation framework structured in two parts: scientific (data collection, analysis) and administrative (meetings, ministerial discussions), with the aim of supporting the functioning of Benin's NITAG. ²²² There is no publicly available evidence to suggest that Benin's National Immunisation Technical Advisory Group (NITAG) is currently active or issuing press releases. Although Benin is recognised as one of the countries in the WHO African Region that has established an NITAG, there have been no recent reports or official announcements detailing its current operations or recommendations.

1.6.1f Presence of an immunization programme for influenza

Score: 0

Benin does not have a national seasonal influenza vaccination program. The Ministry of Health website ²²³, the National Health Development Plan (NHDP) for 2018–2022 ²²⁴, the National Health Security Plan (NAPHS) for 2019–2021 ²²⁵, the Joint External Evaluation (JEE) for 2017 and 2023 ²²⁶²²⁷ and the World Health Organization (WHO) website ²²⁸ all contain no information on this topic. No official source confirms the availability of free or subsidized influenza vaccines for at-risk groups (children, the elderly, healthcare workers). Vaccines may be available in the private sector or for travelers but they are not part of routine immunization protocols. ²²⁹ Regional and global analyses show that in many low- and middle-income tropical countries, influenza vaccination is not targeted in routine protocols and remains poorly accessible. This situation is common in the region, where influenza is not a priority in national immunization programs. In 2015, the World Health Organization (WHO) published a systematic review assessing the use of seasonal influenza vaccines in low- and middle-income countries in the tropics and subtropics. While some countries in Latin America and the Caribbean had implemented seasonal influenza vaccination programmes, the review found that most countries in Asia and Africa had not introduced seasonal influenza vaccines into their national policies and programmes. ²³⁰ Furthermore, the WHO's Global Influenza Strategy 2019–2030 encourages countries to implement policies and programmes for the prevention and control of seasonal influenza. However, uptake of these recommendations has been uneven, with many low- and middle-income countries still lacking comprehensive seasonal influenza vaccination strategies. ²³¹

1.7.1a Strategy/plan for resilience of health system

Score: 100

There is evidence that the country has a strategy or plan to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose, which includes the threat of infectious diseases. The National Adaptation Plan (NAP) to climate change, published in 2022 by the Beninese government in collaboration with the UNDP (United Nations Development Programme) and GIZ (German Society for International Cooperation), explicitly includes health as a priority sector. ²³²²³³
Table 15 (Adaptation options and measures selected for the health sector) of the NAP covered the measures that will affect the health sector; specifically, Objective 2, Reduction in the prevalence of climate-sensitive diseases, includes measures such as "Development of a research program on the impacts of climate change and strategies to combat prevalent diseases," "Development and implementation of a communication plan for the effective and efficient management of climate-sensitive diseases" and "Promoting health insurance against climate risks" (pp. 81-82). ²³⁴

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 0

The national laboratory system lacks the capacity to perform at least five of the ten basic diagnostic tests defined by the WHO. This is not evidence on the websites of the Ministry of Health ²³⁵ or the Ministry of Higher Education and Scientific Research ²³⁶. The same applies to the National Health Development Plan (NHDP) for 2018–2022 ²³⁷ and the National Health Security Plan (NAPHS) for 2019–2021 ²³⁸. WHO documents provide precise information on national laboratories' capacity to perform the ten recommended basic tests as part of the Joint External Evaluation (JEE) assessment. The 2017 JEE report indicates that the central laboratory has the capacity to perform certain diagnostics, such as HIV serology, tuberculosis microscopy and malaria rapid testing ²³⁹. Other key tests include measles, yellow fever, cholera and meningitis, but capacities are not confirmed for five key tests in public documentation ²⁴⁰²⁴¹. Nevertheless, there is no information on the subject in the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023. ²⁴² Additionally, the WHO database of the States Party self-assessment annual reporting tool (SPAR) indicates a 'limited' capacity for the national laboratory, which further highlights the lack of sufficient public documentation on these tests ²⁴³. There is no publicly available evidence on the websites of the Ministry of Health ²⁴⁴ or the Ministry of Higher Education and Scientific Research ²⁴⁵ that has been updated recently and that reliably demonstrates the capacity to systematically perform at least five basic tests according to JEE criteria.

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence of a national plan, strategy or similar document outlining testing procedures in the event of a public health emergency. This includes considerations relating to testing for novel pathogens, capacity expansion and the definition of testing objectives. This information is not available on the websites of the Ministry of Health ²⁴⁶ or the Ministry of Higher Education and Scientific Research ²⁴⁷. The same applies to the National Health Development Plan (NHDP) for the period 2018–2022. ²⁴⁸ According to the 2017 Joint External Evaluation (JEE) conducted by the World Health Organization (WHO), Benin has no official national plan or document regarding testing in a public health emergency, including screening for novel pathogens and defining testing objectives (p11) ²⁴⁹. The report states that 'a national multi-hazard emergency preparedness and response plan to ensure essential IHR capacities has not yet been prepared' (p. 29). There is no mention of a strategy to authorise additional laboratories in the event of a need to rapidly increase testing capacity. ²⁵⁰ Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that, "procedures to improve health and safety interaction in the event of a health emergency must be drawn up"(p. 47). ²⁵¹ The National Action Plan for Health Security 2019–2021, also developed under the auspices of the WHO, identifies priorities such as strengthening the national laboratory system, staff training and the information system (p. 21). ²⁵²²⁵³ However, it does not explicitly define operational protocols for the emergency detection of new pathogens or for increasing capacity or defining quantified testing targets in the event of an imminent health alert. ²⁵⁴²⁵⁵

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

There is no public evidence that a national laboratory serves as an accredited reference institution (e.g. according to ISO 15189:2003 or US Clinical Laboratory Improvement Amendments (CLIA) regulations). This information is not available on the websites of the Ministry of Health ²⁵⁶, the Ministry of Higher Education and Scientific Research ²⁵⁷. The same applies to the National Health Development Plan for 2018–2022 ²⁵⁸ and the National Health Security Plan for 2019–2021. ²⁵⁹ In 2011, a project funded by USAID/WARN-TB has aimed to help the Cotonou National Tuberculosis Reference Laboratory obtain ISO 15189 accreditation. ^260261262 However, no official announcement or recent documentation confirms that this accreditation has been obtained. Lists of organisations accredited according to ISO 15189 (SLMTA, South African National Accreditation System (SANAS), College of American Pathologists (CAP)) do not mention any Beninese laboratories. ^263264265 To date, no national reference establishment has been officially recognised as accredited according to these international standards.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is a national reference laboratory that is subject to external quality assurance. Since November 2017, the World Health Organization (WHO) has officially designated Laboratoire de Référence des Mycobactéries (LRM) of Cotonou as a Supranational Reference Laboratory (SRL) for the African region. ²⁶⁶ It is now responsible for supervising and evaluating tuberculosis (TB) diagnostics, screening and confirmatory tests in several neighbouring countries. According to the WHO and the US Centers for Disease Control (CDC), Benin's national tuberculosis laboratory is now the third SRL in Africa. ^{267268269270271} The laboratory receives ongoing support from the TB Laboratory Project (Global Fund/WHO), particularly with regard to its quality management system (QMS), as well as its participation in external quality assessment (EQA) programmes for microscopy, culture, and anti-TB drug susceptibility testing. ²⁷²²⁷³. Furthermore, according to Fondation Mérieux, RESAOLAB and the assessment named "RESAOLAB: West African network of laboratories to enhance the quality of clinical biology" (2015, "Abstract" section), Benin is part of the RESAOLAB network, coordinated by the foundation, which implements programmes to supervise laboratories, carry out EQA and strengthen technical skills (in haematology, biochemistry and microbiology). ^274275276

2.2.1a Nationwide specimen transport system

Score: 0

A national sample transport system is in place in Benin but it is not fully fonctional. The 2019–21 National Action Plan for Health Security (NAPHS) establishes a system for the transfer and transport of samples that includes standard operating procedures, staff training and appropriate equipment, such as vehicles for the active transport of infectious samples. The plan incorporates provisions to strengthen coordination, surveillance, laboratories and emergency response, but it is not a regulatory text. Instead, it establishes strategic objectives and activities, such as the development of standard operating procedures (SOP's) for outbreak detection, sample transportation, biosafety and multi-sectoral coordination. The plan itself does not provide detailed information on these SOPs, which are expected to be elaborated on in sectoral guidelines and technical manuals produced by the Ministry of Health and partner agencies.²⁷⁷ Additionally, the Ministry of Health has developed national standards and guidelines for HIV/AIDS testing, including specific recommendations for transporting biological samples, such as using coolers and appropriate tubes ²⁷⁸²⁷⁹. According to the official X (formerly Twitter) account of FAO Benin, national workshops have also been held in collaboration with international partners such as the Food and Agriculture Organization of the United Nations (FAO) to establish a system for the secure transport of local biological samples to laboratories ²⁸⁰. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, notes that there is an instruction manual for a specimen transport system but that it is not followed in many cases. (p. 33). ²⁸¹

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no evidence of a plan to rapidly authorise or license laboratories to increase the capacity of the national public health laboratory system to scale up testing during an outbreak. This information is not available on the websites of the Ministry of Health ²⁸², the Ministry of Higher Education and Scientific Research ²⁸³, or the World Health Organization (WHO) ²⁸⁴. The 2018–2022 Health Development Plan (NHDP) ²⁸⁵ provides for the strengthening of infrastructure and the availability of laboratory equipment and logistics, but does not mention any accelerated approval or licensing mechanism for opening or operating laboratories in health emergencies. The 2019–2021 National Action Plan for Health Security (NAPHS) ²⁸⁶ aims to improve the early detection and response to health emergencies (p21); however, it does not mention any special regulatory procedure for rapidly authorising additional laboratories in epidemic situations.

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

Benin conducts continuous surveillance and analysis, based on events and indicators, of notifiable infectious diseases and new emerging diseases. These activities are carried out on a weekly, monthly, or annual basis. Since 1999, the US Centers for Disease Control and Prevention (US CDC) has been working with the Ministry of Health to strengthen surveillance and data analysis capabilities through the Field Epidemiology Training Program (FETP). Since 2016, this program has been training field epidemiologists to detect, analyze, and monitor infectious disease outbreaks. This training has enabled regular, often monthly, data supervision and analysis. ²⁸⁷ Graduates of the FETP submit weekly epidemiological surveillance reports to higher levels of the health system: approximately 96% of districts regularly participate in these weekly reports. ²⁸⁸ The National Council for the Fight against HIV/AIDS, Tuberculosis, Malaria, Hepatitis, STIs, and Epidemics (created in 2018) is the supreme body for coordination and epidemiological surveillance of notifiable diseases in Benin. ²⁸⁹ According to the assessment entitled "Analysis of the determinants of SARS-CoV-2 infection in Benin in 2021" (2023, "Introduction" section), the country has also set up sentinel surveillance for COVID-19 through the STREESCO project (2021), which covers several sites and enables the regular collection and analysis of epidemiological data.²⁹⁰ Nevertheless, there is no publicly available weekly epidemiological bulletins or annual disease surveillance reports issued by the Ministry of Health in Benin, either on the ministry's websites or on the WHO's African regional platforms. However, in the past (e.g. 2017–2019), the WHO AFRO published Outbreaks and Emergencies Bulletins which sometimes included event summaries related to Benin. While these regional bulletins offer situational overviews across West Africa, they are not specific to Benin. They do not substitute for national reporting, and there is no evidence that the government regularly or consistently publishes a Benin-specific epidemiological bulletin. ²⁹¹

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is evidence that Benin has an IHR focal point but insufficient evidence that it strictly complies with the International Health Regulations (IHR-2005) deadlines for notifying the World Health Organization (WHO) of notifiable diseases. The Ministry of Health website ²⁹², the National Health Development Plan (NHDP) for 2018–2022 ²⁹³, and the National Health Security Plan (NAPHS) for 2019–2021 ²⁹⁴, all contain no information on this topic. The 2017 Joint Evaluation of Essential IHR Capacities (JEE) ²⁹⁵ report for Benin acknowledges the existence of a focal point, but deems its functions to be ineffective (p2, p31). Furthermore, the 2020 State Party Annual Reporting (SPAR) suggests limited implementation and coordination of notification mechanisms within the required timeframes, assessing the capacity of the national focal point at only 40%. ²⁹⁶ The 2020 SPAR report also assesses the capacity of the national focal point as only 40%.²⁹⁷ The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, does not contain evidence of a comprehensive public document confirming a significant improvement in the capacities of the IHR focal point is yet available. ²⁹⁸ Moreover, the 2023 JEE states that "the RSI focal point has been appointed," but "general instructions or guidelines for coordination between the RSI national focal point and the other players involved must be defined" (p. 14). ²⁹⁹

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

There is evidence that Benin operates an electronic surveillance reporting system at national and subnational levels. The 2017 Joint External Evaluation (JEE) report states that 'there is an electronic system for reporting surveillance data that is used by stakeholders at national, intermediate and peripheral levels ³⁰⁰. Moreover, the JEE 2023 states that "a functional integrated disease surveillance and response system is available at all levels, including the community level: indicator-based surveillance." (p35). ³⁰¹ Benin is also a member of regional disease surveillance networks, such as the West African Health Organisation (WAHO). However, there are reports that these systems are inefficient within Benin ³⁰². Successive editions of the National Strategy for the Development of Statistics (SNDS)—SNDS-1 (2008–2012), SNDS-2 (2014–2016) and SNDS-3 (2020–2023) were published by the Institut National de la Statistique et de la Démographie (INStaD). INStaD is supervised by the Ministry of Development and Coordination of Government Action, and coordinates the National Statistical System (SSN). —emphasise strengthening the collection, monitoring and dissemination of statistical data, paying particular attention to decentralising and digitalising information systems. ^303304305. The first edition mentions the need to modernise information systems but does not directly address electronic health surveillance ³⁰⁶. However, the second edition provides a clear strategic framework for developing electronic surveillance systems at the decentralised level ³⁰⁷. The most recent edition confirms that Benin is seeking to institutionalise structured electronic data collection, which is directly linked to electronic surveillance ³⁰⁸. According to the assessment entitled "Quality of the information and monitoring system for health interventions in areas exposed to results-based financing in 2014 in Benin" (2017, Methods -Study framework and methods – Study framework section) ,the system relies on the District Health Information System 2 (DHIS2) platform to capture surveillance data (morbidity, suspected cases and immediately notifiable diseases) from health centres to the national level ³⁰⁹³¹⁰. It aggregates surveillance indicators, supports outbreak alerts and informs decision-making processes. However, although data feeds into national systems, regular public bulletins are not consistently published. ³¹¹

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is no recent public evidence confirming that the data is available in real time and is broken down by indicators such as age or ethnicity. The Ministry of Health website³¹² and the National Health Security Plan (NAPHS) for 2019–2021 ³¹³ contain no information on this topic. According to the RESAOLAB network's website section "Support Surveillance", the country is part of it (2009), which has deployed the LabBook system (an open source LIMS) in its laboratories to electronically manage the entry of clinical data and test results, as well as their automated transmission to national health authorities and District Health Information Software 2 ( DHIS2 – 2017). Still according to this section, this LIMS improves data collection, but there is no public documentation indicating that this data is collected continuously or in real time, nor that breakdowns by age, gender, ethnicity, or origin are produced. The country uses DHIS2 for epidemiological surveillance, which can theoretically integrate laboratory results; however, there is no public confirmation that this functionality is used demographically in Benin. ³¹⁴³¹⁵

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 7 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.³¹⁶

Moreover, as part of the Global Polio Eradication Initiative (GPEI), Benin organized a response campaign against the 27 cases of cVDPV2, including 3 isolated cases of Acute Flaccid Paralysis (AFP) and 4 from environmental surveillance in 2023, and 20 isolated cases in 2022 including 12 cases of AFP and 8 from environmental surveillance. While this suggests ES is being conducted regularly, there is insufficient evidence as to whether this is at a national level, whether it is still ongoing or whether it is conducted by or in collaboration with the Benin government. ³¹⁷

Moreover, according to the 2025 Q4 Polio Environmental Surveillance Bulletin, published by the WHO and the GPEI, the Polio Eradication Programme (PEP), WHO Africa Regional Office (AFRO), have supported capacity-building in Benin, which is a priority country, through a refresher training session for ES focal points from government and supporting partner agencies.³¹⁸

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records are not commonly in use, but there is evidence they are used. There is no evidence of their use on the websites of the Ministry of Health ³¹⁹ or the Ministry of Higher Education and Scientific Research ³²⁰ . Legislative frameworks exist for the protection of personal data, including articles 4 and 6 of Law No. 2009-09 of 22 May 2009 "on the protection of personal data in the Republic of Benin" ³²¹ and article 307 of the Digital Code through Law No. 2017-20 of 20 April 2018 ³²², which cover health data as sensitive data. However, no decree or regulatory text mandates the use of electronic medical records. Nevertheless, Health Security (NAPHS 2019–2021) emphasizes strengthening health information systems and digital reporting mechanisms, which includes digital record-keeping initiatives ³²³. The National Health Development Plan (2018–2022) ³²⁴ contains strong strategic guidelines for e-health. It explicitly mentions the implementation of a computerised patient record system and an e-services management platform for the health sector (p. 12, p. 41). It also proposes a governance framework for e-health and telemedicine, as well as an electronic document archiving mechanism (p. 42). Furthermore, the MEDECIS project, developed by Emmanuel Gbavou, is a private initiative aimed at automating patient record management via several applications (MediCAL, MediPAD, MédiCIS). ³²⁵ However, it has not been widely adopted within the national health system.

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that the national public health system has access to individuals' electronic medical records (EMRs) within the country. There is also no mention of this on the websites of the Ministry of Health ³²⁶ and the Ministry of Higher Education and Scientific Research ³²⁷. This topic is also not addressed in the National Action Plan for Health Security 2019-2021 (NAPHS) ³²⁸. There is no legal or regulatory basis authorising widespread access by health authorities to electronic patient records. The legal framework neither provides for the centralisation of EMRs nor for their mandatory sharing with public institutions, and the protection of personal data is regulated without any explicit exemption for EMRs ³²⁹³³⁰. The 2018–2022 National Health Development Plan (NHDP) identifies several actions, including the implementation of computerised patient records, an electronic health services platform, and an electronic document archiving mechanism (p12,p41,p42) ³³¹. However, these provisions concern the creation and management of EHRs rather than widespread access to data by health authorities. There is no widespread EHR system in the Beninese health system. Most records are paper-based and digital systems are fragmented or experimental, often limited to certain specialised structures or programmes (such as the Satmed system for teleconsultations in two maternity wards) ³³².

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no evidence to suggest the existence of data standards that guarantee data comparability (e.g. ISO norms). This topic is also not addressed on the websites of the Ministry of Health ³³³ or the Ministry of Higher Education and Scientific Research ³³⁴. This topic is not addressed in the National Action Plan for Health Security 2019–2021 (NAPHS) ³³⁵ or the National Health Development Plan 2018–2022 (NHDP) ³³⁶. No legal or regulatory text mentions ISO or equivalent standards applied to health data in the national public health system ³³⁷³³⁸. The National Agency for Standardisation, Metrology and Quality Control (ANM), in its article named "Benin: SAN and NAM raise awareness of international sanitation standards", promotes certain ISO standards in sectors such as sanitation (ISO 30500, 24521, 31800), but not in the healthcare or medical data sector ³³⁹. According to the articles entitled "Health sector in Benin: RAS members officially installed" by the Beninese's presidency and "Accountability Session: ARS Examines Progress in Patient Safety in Benin" by the Beninese's governement, the Health Sector Regulatory Authority is responsible for establishing quality and regulatory standards in healthcare, pharmacy, and telemedicine, but its remit does not mention any specific data or digital health standards ³⁴⁰³⁴¹.

2.4.2a Data sharing mechanisms

Score: 0

Although Benin has formal structures for animal, human, and wildlife surveillance, there is no evidence of a permanent, fully operational mechanism for routine data sharing across these sectors. Although Benin has formal structures for animal, human, and wildlife surveillance—such as the Livestock Directorate under Decree No. 2021-563 of 3 November 2021 ³⁴², the wildlife management provisions under Decree No. 2011-394 of 28 May 2011 ³⁴³, the REDISSE III project for strengthening disease surveillance ³⁴⁴³⁴⁵, and wildlife monitoring by CENAGREF ³⁴⁶—there is no evidence of a permanent, fully operational mechanism for routine data sharing across these sectors. Occasional interactions between the Ministries of Health, Agriculture, and Environment are noted in the WOAH PVS Monitoring Report ³⁴⁷, and intersectoral training and project-based initiatives (e.g., AFENET, REDISSE III) aim to improve collaboration ³⁴⁸³⁴⁹. However, these activities remain project-driven or ad hoc, and there is no demonstrated integrated system for real-time exchange of surveillance information among human health, animal health, and wildlife authorities. Therefore, based on these references, Benin does not meet the threshold for an established multisectoral data-sharing mechanism.

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

There is no evidence that the country publishes anonymised infectious disease surveillance data on government websites (such as those of the Ministry of Health, the Ministry of Agriculture, or similar) in the form of reports or other formats. This topic is not addressed on the websites of the Ministry of Health ³⁵⁰, the Ministry of Agriculture ³⁵¹, the Ministry of Higher Education and Scientific Research ³⁵² and the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023. ³⁵³ It is also not mentioned in the National Action Plan for Health Security 2019–2021 (NAPHS) ³⁵⁴ or the National Health Development Plan 2018–2022 (NHDP) ³⁵⁵. The 2017 Joint External Evaluation (JEE) report indicates that the government has established a list of zoonotic diseases to monitor by decree since 2001, and that there are prevention plans in place for some of these diseases, such as avian flu, anthrax, rabies and haemorrhagic fevers (p. 12). However, the report emphasises that there is no regular exchange of public data, and that these plans are not publicly available. ³⁵⁶ The Benin Health Profile, published by the WHO Regional Office, provides an overview of general health indicators, but does not provide access to up-to-date, anonymised infectious disease surveillance data. ³⁵⁷ According to the assessment "Improving the reliability of SNIGS data: revised information collection tools available" (2020), the National Health Information and Management System (SNIGS), based on the DHIS2 platform, collects epidemiological surveillance data for internal planning purposes. However, this data is not made available online for public consultation. ³⁵⁸³⁵⁹

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There are laws and/or regulations protecting the confidentiality of identifiable medical information, such as that generated by health surveillance activities. Law No. 2009-09 of May 22 2009, on the protection of personal data establishes, through article 1, a framework for the lawful, fair, and transparent processing of personal data, including sensitive data such as health data: "This law applies to the automatic processing of personal data, contained or intended to be contained in digitized files, in whole or in part, or manual files". ³⁶⁰³⁶¹ The Beninese Digital Code, via Law No. 2017-20 of April 20, 2018, through article 394, defines health data as sensitive data requiring prior authorization for any processing. It also implies an obligation to declare or authorize to the Data Protection Authority (PDPA) for any collection or processing: "The personal data referred to in paragraph 1 may be processed for the purposes set out in paragraph 2, point 8, if such data is processed by or under the responsibility of a health professional subject to an obligation of professional secrecy in accordance with the law of the Republic of Benin or the rules laid down by the competent national bodies, or by another person also subject to an obligation of secrecy in accordance with the law of Benin or the rules laid down by the competent national bodies." ³⁶² The independent Personal Data Protection Authority (PDPA) ensures the enforcement of these laws, authorizes or prohibits processing, receives complaints, and can impose sanctions for violations (fines, injunctions, suspension) ³⁶³.

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no evidence of legislation or regulation in place to protect the confidentiality of identifiable individual medical information generated by health surveillance activities or to safeguard against cyberattacks (e.g. ransomware). This topic is not addressed on the websites of the Ministry of Health ³⁶⁴ , the Ministry of Digital affairs ³⁶⁵ , or the Ministry of Higher Education and Scientific Research ³⁶⁶. Law No. 2009-09 of May 22 2009, on the protection of personal data establishes, through article 1, a framework for the lawful, fair, and transparent processing of personal data, including sensitive data such as health data: "This law applies to the automatic processing of personal data, contained or intended to be contained in digitized files, in whole or in part, or manual files" ³⁶⁷³⁶⁸. The Beninese Digital Code, via Law No. 2017-20 of April 20, 2018, through article 394, defines health data as sensitive data requiring prior authorization for any processing. It also implies an obligation to declare or authorize to the Data Protection Authority (PDPA) for any collection or processing: "The personal data referred to in paragraph 1 may be processed for the purposes set out in paragraph 2, point 8, if such data is processed by or under the responsibility of a health professional subject to an obligation of professional secrecy in accordance with the law of the Republic of Benin or the rules laid down by the competent national bodies, or by another person also subject to an obligation of secrecy in accordance with the law of Benin or the rules laid down by the competent national bodies". ³⁶⁹ The Personal Data Protection Authority (PDPA) is an independent authority that oversees the enforcement of these laws, authorises or prohibits data processing, receives complaints and can impose sanctions (fines, injunctions and suspensions) in the event of violations ³⁷⁰. Nevertheless, there is no public evidence to suggest that it has received or adjudicated complaints specifically relating to the processing of medical information from health surveillance systems. Its remit clearly extends to sensitive health data, yet there is no evidence of specific public guidance or detailed rulings with a sole focus on health surveillance systems. Instead, the APDP applies the general data protection principles set out in Law No. 2009-09 and the 2017 Digital CodeThe National Agency for Information Systems Security (ANSSI-Benin)³⁷¹, established by Decree No. 2018-529 on 14 November 2018³⁷², is responsible for developing and promoting security measures for the state's digital systems. However, it does not explicitly address the security of medical data against cyberattacks ³⁷³.

2.4.5a Cooperative commitments or agreements within regions

Score: 50

Benin has pledged to share surveillance data of one diesease in the event of a public health emergency. This commitment forms part of the multilateral agreements with the World Health Organization (WHO) ³⁷⁴, US Centers for Disease Control and Prevention (CDC)³⁷⁵, and Economic Community of West African States (ECOWAS) ³⁷⁶ that Benin has demonstrated its commitment to implementing. However, there is no Beninese legislation dedicated specifically to this obligation outside the framework of the 2005 International Health Regulations (IHR). The IHR requires all States Parties, including Benin, to promptly notify the WHO of health events of international concern via the national focal point however there are no provisions to share this information with countries directly.³⁷⁷ Furthermore, during the Lassa fever epidemics between 2017 and 2019, Benin collaborated with Nigeria, Togo and the West African Lake Basin Authority (WALBA) by deploying rapid response teams, conducting contact tracing, reinforcing infection prevention and control measures in health facilities, and crucially strengthening cross-border cooperation and information exchange in order to collectively manage risks with the goal of timely, accurate epidemiological data exchange and coordinated outbreak response across regional boundaries. ³⁷⁸ No further information is available regarding other collaborations on the Ministry of Health website, ECOWAS website and World Health Organization website, even during the pandemic. ^379380381 At the continental level, the US CDC's strategic framework (2024) calls for the strengthening of cross-border surveillance and information sharing among African Union member states. As a member of ECOWAS, Benin is involved in this initiative. ³⁸²

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no evidence of a national system put in place to provide subnational support, such as training, standardisation of measures and financial resources, to conduct contact tracing in the event of a public health emergency. During the COVID-19 crisis, the World Bank financed the national response plan to the pandemic with approximately USD 42 million. This included 105 training sessions on surveillance, contact tracing, case management and risk communication, as well as the implementation of 80 mobile rapid response teams for case investigation at district level. ³⁸³ The country has developed its field epidemiology capacity through the Field Epidemiology Training Programme (FETP), which is supported by the US Centres for Disease Control and Prevention (CDC). In 2024, two cohorts totalling 50 professionals were trained, including 44 from the Ministry of Livestock and six from the Ministry of Health. This training incorporates the principles of the One Health approach to intersectoral surveillance.³⁸⁴³⁸⁵ Additionally, 15 new field epidemiologists from the Ministries of Health and Agriculture graduated in 2023. This training forms part of the Global Health Security Agenda. ³⁸⁶ Moreover, Both Benin’s National Action Plan for Health Security (2019–2021) and the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, emphasise the need to strengthen contact tracing and field epidemiology capacity as part of a broader, coordinated preparedness strategy. Both plans emphasise the need for sustainable financing, standardised training and the integration of a One Health approach across ministries (pp. 83-84 of NAPHS and p. 13 of the 2023 JEE). They also emphasise the importance of rapid response teams and digital tools to enhance surveillance and investigation (p. 15 of NAPHS and p. 14 of the 2023 JEE). ³⁸⁷³⁸⁸ Although partners (e.g. the World Bank and the CDC) have supported implementation, the national plans provide the overarching framework to institutionalise these capacities beyond emergency contexts.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no evidence that the country provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support (paycheck, job security) and medical attention. No information on this subject is available on the Ministry of Health's website. ³⁸⁹ Furthermore, the strategic documents (the National Health Development Plan (2018–2022) (NHDP) ³⁹⁰ and the National Action Plan for Health Security (2019–2021) (NPHS) ³⁹¹ do not explicitly mention any dedicated economic or social support for infected individuals or their contacts. According to the health measures implementation report published on the Directorate General of the Budget's website, the National COVID-19 Response Plan details the following strategic areas: coordination, surveillance, care, laboratories, communication, logistics and financing. ³⁹²³⁹³ However, there is no indication of specific social or economic support. Nevertheless, according to the Minutes of the Council of Ministers of June 10, 2020, the Beninese government has launched an extensive aid programme as part of its pandemic response, providing 74.12 billion CFA francs (132 Million USD) to support businesses, artisans, and impoverished households in the form of salary payments, electricity subsidies, cash transfers, and tax exemptions.³⁹⁴ According to the article "Benin: All social classes benefit from subsidies to cope with Covid-19, with financial support from the African Development Bank", thanks to support from the African Development Bank, more than 23,700 artisans, drivers and traders received direct subsidies and support was provided to 544,609 vulnerable households. ³⁹⁵ As stated in World Bank article "Benin: Free access to care for COVID-19 patients", in terms of healthcare, treatment centres across the country, particularly the Allada facility, provided free treatment for patients with the virus. ³⁹⁶

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no primary evidence of a cooperative agreement between the public health system and border control authorities to identify suspected and potential cases among international travellers, trace their contacts, and quarantine them in the event of a public health emergency. No relevant information was found on the Ministry of Health ³⁹⁷, the Ministry of Higher Education and Scientific Research ³⁹⁸, and Ministry of Agriculture's websites ³⁹⁹. Border control authorities do not have official website. No official text (decree, law or public protocol) was found on the websites of Droit-Afrique, WIPO Lex and Journal Officiel de la République du Bénin, that establishes formal cooperation between the Beninese public health system and border control authorities (customs, aviation and immigration) to identify suspected cases among international travellers, trace their contacts or implement quarantines. ^400401402 The 2017 Joint External Evaluation (JEE) report scores the section 'Public health and security authorities (e.g. law enforcement, border control, customs) linked during a suspect or confirmed biological event' as '2', meaning there is limited capacity (p34). The report also states that there is a lack of written standard operating procedures or agreements for the joint coordination of operations during public health emergencies (p. 33). There is also no agreement on sharing information on risks during events likely to threaten public health and safety (p. 33). No updated information has been found since the JEE was published. ⁴⁰³ The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that Benin needs to "develop and implement a plan for training security and defense forces in emergency situations" (p.5). Moreover, it states that "in Benin, relations between the public health and national security authorities are defined through the texts governing the creation of their respective structures. In emergency situations involving public health, biological or radiological events, functional coordination is put in place, enabling a synergy of interventions. However, this interrelationship is not linked to defined and disseminated operational procedures." (p. 46). ⁴⁰⁴

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Benin has an applied epidemiology training program (such as the Field Epidemiology Training Program – FETP), and the government provides resources to send citizens abroad to participate in such programs. The 2017 Joint External Evaluation (JEE) report states that "Benin has developed an introductory FETP programme and sends two or three physicians abroad each year for advanced FETP training" (p. 27). However, the report also notes that 'Despite these strengths, Benin's weaknesses include an insufficient number of field epidemiologists' (p2)⁴⁰⁵. the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "field epidemiologists and members of the rapid response teams take part in training courses at central and intermediate levels." (p. 40). ⁴⁰⁶ The FETP has been well established in Benin since 2016, offering a national training programme for healthcare personnel. Frontline and intermediate-level training is offered to public health professionals ⁴⁰⁷⁴⁰⁸. According to the US CDC, in 2023, 15 participants from 12 provinces completed the intermediate level of the FETP ⁴⁰⁹.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is sufficient evidence that field epidemiology training programmes explicitly include animal health professionals and that specific training in field epidemiology for animal health professionals is offered. The 2017 Joint External Evaluation (JEE) report states that field epidemiology training is available to the "veterinary or animal health workforce" (p. 13). ⁴¹⁰ Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that, "field epidemiologists and members of the rapid response teams take part in training courses at central and intermediate levels." (p. 40). ⁴¹¹ However, available information suggests that the Field Epidemiology Training Program (FETP) in Benin primarily targets human health professionals. However, no documentation explicitly mentions the inclusion of veterinarians or animal health professionals in these cohorts. ⁴¹² The National Action Plan for Health Security (2019–2021) includes a component dedicated to developing human resources. This component explicitly mentions the implementation of a programme to train applied epidemiologists from both the human and animal health sectors via SIMR (Integrated Disease Surveillance and Response) training sessions at multiple levels (frontline and intermediate) (p. 91) ⁴¹³. According to the article entitled "Training of veterinary professionals in field epidemiology", the ISAVET programme (developed by the Food and Agriculture Organization with the support of USAID and other partners) offers veterinary professionals a basic-level module in field epidemiology. Although this programme is regional, it can be adapted to the Beninese context via national evaluations. ⁴¹⁴

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

There is public evidence that the country has at least one qualified field epidemiologist per 200,000 inhabitants. This issue is not addressed on the websites of the Ministry of Health ⁴¹⁵, the Ministry of Digital Affairs ⁴¹⁶, or the Ministry of Higher Education and Scientific Research ⁴¹⁷. However, the US Centers for Disease Control and Prevention (CDC) reports that there are 99 FETP-Frontline graduates and 15 FETP-Intermediate graduates in Benin (a total of approximately 114 people). However, with an estimated population of approximately 14.11 million in 2023, the country would need approximately 71 epidemiologists to meet the goal of one epidemiologist per 200,000 inhabitants. The number of reported graduates exceeds this target of 71 epidemiologists ⁴¹⁸⁴¹⁹. However, public figures include graduates (Frontline + Intermediate), whereas the official Joint External Evaluation (JEE) ratio targets "qualified" epidemiologists in post and available for response ⁴²⁰. Furthermore, the 2017 JEE noted a historical shortage of qualified personnel and recommended increasing and retaining staff⁴²¹⁴²². It is therefore important to verify the retention and geographic distribution of graduates to confirm their actual operational capacity. Moreover, the 2023 JEE states that "staff capacity for surveillance needs to be strengthened (new agents and hospital surveillance focal points, etc.)" (p. 36). It should be noted, however, that "ongoing training and formative supervision have been carried out to reinforce staff skills/capacities" (p. 39). ⁴²³ However, no additional information is available on this subject.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

Disease-specific plans are in place, but there is no evidence of an overarching plan. Official publications and sectoral plans, discussed below, are not centralised and remain separate. The Ministry of Health website contains no information on this topic. ⁴²⁴ While the National Health Development Plan (2018–2022) include guidance for emergency management, this is a sectoral public health framework (p11). ⁴²⁵ While the National Action Plan for Health Security (2019–2021) meets the requirements of the International Health Regulations with a multi-pathogen component, it is time-limited (p6). ⁴²⁶ In response to the pandemic, Benin developed a National Integrated Response Plan for the Coronavirus Disease 2019 (2021–2025), funded in particular by the United Nations Development Programme (UNDP), which incorporates public health and social protection strategies.⁴²⁷ However, the World Health Organization portal indicates that there is no published national or multi-hazard public health emergency plan (SPAR 2024 score for Benin: NAPHS rating 'No Plan or Plan not publicly available'). ⁴²⁸ Nevertheless, Benin has developed a plan in response to the pandemic. Aside from this specific plan for the pandemic, there is currently no comprehensive, multisectoral and multistakeholder national plan dedicated to public health crisis preparedness and response in Benin.

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

There is no public evidence of an overarching plan that has been updated within the last three years. Official publications and sectoral plans, discussed below, are not centralised and remain separate. The Ministry of Health website contains no information on this topic. ⁴²⁹ While the National Health Development Plan (2018–2022) includes guidance for emergency management, this is a sectoral public health framework (p. 11) ⁴³⁰. While the National Action Plan for Health Security (2019–2021) meets the requirements of the International Health Regulations with a multi-pathogen component, it is time-limited (p. 6). ⁴³¹ In response to the pandemic, Benin developed a National Integrated Response Plan for the Coronavirus Disease 2019 (2021–2025), funded in particular by the United Nations Development Programme (UNDP), which incorporates public health and social protection strategies.⁴³² However, the World Health Organization portal indicates that there is no published national or multi-hazard public health emergency plan (SPAR 2024 score for Benin: NAPHS rating 'No Plan or Plan not publicly available').⁴³³ Nevertheless, Benin has developed a plan in response to the pandemic. Aside from this specific plan for the pandemic, there is currently no comprehensive, multisectoral and multistakeholder national plan dedicated to public health crisis preparedness and response in Benin.

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no publicly available evidence that Benin has adopted a comprehensive national health emergency response plan that covers multiple types of threats, such as antimicrobial resistance, zoonoses and biological accidents, in a single document or coordinated system. Official publications and sectoral plans, discussed below, are separate and not centralised. The Ministry of Health website contains no information on this topic⁴³⁴. The National Health Security Action Plan (NHSAP 2019–2021) ⁴³⁵ is a multi-risk, multi-sector plan that covers prevention, detection, emergency response and coordination in accordance with the requirements of the International Health Regulations (IHR) ⁴³⁶. While it addresses infectious threats such as cholera, haemorrhagic fever and avian influenza epidemics, it does not explicitly mention biological accidents or deliberate acts (p. 5). Additionally, the National Health Development Plan (NHDP 2018–2022) strengthens health systems by addressing communicable diseases and equity without formally articulating them within a comprehensive threat mechanism (p. 31). ⁴³⁷ According to the assessment titled "Overview of antimicrobial resistance mitigation efforts in Benin 2024" (2025), while the National Plan to Combat Antimicrobial Resistance (2018–2023) does exist, it is neither integrated into an accessible, all-in-one national health emergency plan nor explicitly linked to pandemic preparedness. ⁴³⁸

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is no publicly available evidence that Benin has adopted a comprehensive national health emergency response plan which covers multiple threats such as antimicrobial resistance, zoonoses and biological accidents; therefore, it cannot explicitly includes health equity or mechanisms that consider the needs of vulnerable populations (except for COVID). The Ministry of Health website ⁴³⁹ and the National Health Security Plan (NAPHS) for 2019–2021 ⁴⁴⁰ all contain no information on this topic. The 2017 Joint External Evaluation (JEE) ⁴⁴¹ report on Benin highlights this absence and recommends creating a unified national health emergency management plan. Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that Benin should "put in place a regulatory framework and mobilize resources to facilitate the implementation of research, development and innovation in emergency preparedness and response" (p. 5) as a priority measure. ⁴⁴² While the National Health Development Plan (NHDP 2018–2022) (p. 31) acknowledges the importance of equity and targeting vulnerable groups (women, children and rural populations), they do not align with a One Health, multi-threat health emergency framework. Furthermore, crisis management mechanisms remain focused on specific threats without the systematic integration of health equity or multi-criteria vulnerability (p. p121). ⁴⁴³ Benin has a general emergency response plan for natural disasters known as the National Contingency Plan (Plan de Contingence National). First developed in 2009 and updated in 2015, the plan provides technical guidelines for crisis management and enables preparedness for and response to various hazards, including floods, droughts, epidemics, chemical and radiological threats, and socio-political crises. But it doesn't include health equity or mechanism that consider the needs of populations. The National Civil Protection Agency (ANPC), established by Decree No. 2012-426, provides further institutional support and acts as Benin’s lead authority for disaster risk management, coordinating emergency responses.

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is no public evidence that Benin has specific mechanisms in place to collaborate with the private sector in preparing for and responding to epidemic emergencies. This topic is also not addressed on the websites of the Ministry of Health ⁴⁴⁴ or the Ministry of Higher Education and Scientific Research ⁴⁴⁵. The National Action Plan for Health Security 2019-2021 (NAPHS) ⁴⁴⁶ and the National Health Development Plan 2018-2022 (NHDP) ⁴⁴⁷ also do not address this topic. However, several ad hoc initiatives and projects demonstrate collaborative efforts: the Private Sector Health Partnership Activity (PSHPA), led by Abt Global with support from USAID, for example, strengthens private sector engagement in maternal, newborn and child health. It supports the Private Health Sector Platform (PSSP) in obtaining accreditation, training providers and reporting data to the national DHIS-2 system. ⁴⁴⁸⁴⁴⁹ According to the article "The Health Care System in Benin" (2024), the National Council for the Fight Against AIDS, Tuberculosis, Malaria, Hepatitis and Epidemics (CNLS-TP) plays a national coordinating role in epidemic responses, including surveillance and alerts. It also maintains indirect links with several sectors, including potentially the private sector. ⁴⁵⁰⁴⁵¹

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is no public evidence that Benin has a policy or plan for implementing non-pharmaceutical interventions (NPIs) in the event of an epidemic or pandemic, nor any guidelines for doing so. While some strategic documents, such as the Health Development Plan for 2018–2022 ⁴⁵², the National Action Plan for Health Security for 2019–2021 ⁴⁵³, and the National Multisectoral Plan to Combat Antimicrobial Resistance for 2019–2024 ⁴⁵⁴, refer to the prevention and control of communicable diseases, they lack a detailed operational framework for NPIs (social distancing, isolation, or school closures). Furthermore, according to the Beninese governement, during the 2019–2020 COVID-19 pandemic, it implemented ad hoc non-pharmaceutical measures, supported by public communication campaigns. ⁴⁵⁵⁴⁵⁶ However, these actions were not part of an integrated, intersectoral national strategy.

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

There is evidence that Benin has conducted a national-level biological threat-focused exercise but not that it activated its national infectious disease outbreak emergency response plan in the past year. According to a 7 November 2024 Facebook post from U.S. Africa Command (AFRICOM), Benin held a “live mass casualty response simulation, showcasing the robust capabilities of Benin’s civil and military authorities in handling complex emergency scenarios.” ⁴⁵⁷ No further information on the subject, through scientific or press articles, is available on the websites of the Ministry of Health ⁴⁵⁸ or the WHO ⁴⁵⁹. According to the article named "Benin: A new health plan for effective responses" (2024), in 2024, Benin announced its National Health Development Plan for the period 2024–2030. ⁴⁶⁰ This plan outlines the country's health system objectives and priorities for several years. The plan outlines frameworks and guidelines to strengthen preparedness for and response to health emergencies. However, it is not publicly available and it does not constitute evidence that a national emergency response plan has been effectively activated in response to a specific epidemic. Moreover, there is no evidence that Benin conducted a national exercise focused on biological threats in collaboration with the World Health Organization (WHO) or independently during the 2024–25 period. No information on the subject, through scientific or press articles, is available on the websites of the Ministry of Health ⁴⁶¹ or the WHO. ⁴⁶²

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no evidence that Benin has developed a plan to improve response capacity over the past year. Several years ago, Benin has identified gaps and good practices in its response and developed a capacity improvement plan. In July 2017, the Ministry of Health organised an Action After Review (AAR) ⁴⁶³ following a Lassa fever outbreak. This workshop brought together stakeholders from various sectors (WHO, USAID, Red Cross and the media) to share lessons learned in the areas of surveillance management, coordination, infrastructure, infection prevention and communication. Some parts of the After Action Review (AAR) are publicly available via the WHO SPH portal. The AAR assessed several key functions, including surveillance, the laboratory service, coordination, case management, infection prevention and control, and logistics. Participants included representatives from the Ministry of Health, academia, civil protection, the media, USAID, the Red Cross and WHO. Recommendations included incorporating communication specialists and psychologists into rapid response teams and crisis management, strengthening the private sector's involvement in surveillance activities, and establishing and operationalising interoperable coordination structures at district, departmental and national levels. ⁴⁶⁴ A proposed action plan aimed to strengthen these critical areas by involving the private sector more and calling on psychology specialists. However, the action plan is not publicly available in its entirety ⁴⁶⁵. More recently, the REDISSE-Benin project (2018–2024) ⁴⁶⁶ has conducted thematic reviews of surveillance, preparedness, laboratories and human resources during workshops bringing together project leaders and ministry officials. Thirty-three good practices and ten lessons learned were formalised and recommendations were made to improve preparedness and response to health emergencies. The key recommendations focused on preparedness and response capacity, with a particular emphasis on animal and human health and the One Health approach (summarised from pages 500–503). Strengthening systems for the joint management of epidemic-prone and zoonotic diseases to enhance animal–human health collaboration; improving SOPs; involving wildlife stakeholders and private veterinarians; and reinforcing One Health platforms at all administrative levels; Rapid response and preparedness should be achieved through the conduct of tabletop exercises, improvements to laboratory capacity and biosafety infrastructure, the prepositioning of emergency kits and IPC supplies, and the establishment of multi-sectoral collaboration, including with the education and media sectors. Workforce development can be enhanced through the expansion of the FETP and cascade training across the human, animal and environmental sectors. Veterinarians should be supported through incentives and equipment, and One Health training should be offered in IDSR. While these recommendations are documented as best practices and lessons learned, the report does not provide evidence that they have been implemented. ⁴⁶⁷ According to a 7 November 2024 Facebook post from U.S. Africa Command (AFRICOM), Benin held a “live mass casualty response simulation, showcasing the robust capabilities of Benin’s civil and military authorities in handling complex emergency scenarios.” However, there is insufficient evidence that Benin developed a capacity improvement plan in response. ⁴⁶⁸

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no evidence that Benin has compiled a list of response gaps and best practices over the past year, either through an infectious disease response, an after-action review or a biological threat exercise, and developed a plan to improve its response capabilities. There is no information available on the list on the websites of the Ministry of Health⁴⁶⁹ or the WHO⁴⁷⁰. There are also no scientific or press articles on this topic. Moreover, according to the article named "Benin: A new health plan for effective responses" (2024), in 2024, Benin announced its National Health Development Plan for the period 2024–2030⁴⁷¹. This plan outlines the country's health system objectives and priorities for several years. The plan outlines frameworks and guidelines to strengthen preparedness for and response to health emergencies. However, it is not publicly available as of August 2025.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Benin has a Public Health Emergency Operations Centre (PHEOC). However, information on this subject is scarce. There is no information available on the Ministry of Health website ⁴⁷². Nevertheless, it is cited twice. The first citation is in the World Bank's Natural Disaster Risk Reduction Programme: 'Benin: Strengthening Legal, Institutional and Technical Capacities to Manage Climate Risks, Disasters and Health Emergencies' ("Programme de réduction des risques de catastrophes naturelles : « Bénin : Renforcement des capacités juridiques, institutionnelles et techniques pour la gestion des risques climatiques, des catastrophes et des urgences sanitaires »") ⁴⁷³ . It specifies that Benin "has a finalised Public Health Emergency Operations Centre (COUSP) Operational Plan". It is cited a second time in a World Health Organization article entitled 'WHO equips COUSP with communications equipment worth 107 million FCFA' ("L'OMS équipe le COUSP de matériels de matériels de communications d’une valeur de 107 millions de FCFA") ⁴⁷⁴ . The COUSP is a key structure for coordinating responses to epidemics or other health crises. It collaborates closely with national and international partners. The aim of this collaboration is to ensure a rapid and effective response to health emergencies by ensuring the availability of necessary resources and coordinating the actions of the various actors involved. ⁴⁷⁵ Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, explicitly references a Public Health Emergency Operations Centre (PHEOC, also known as a HEOC) within the 'Health Emergency Management' technical area. Specifically, indicator R.1.2, 'Public Health Emergency Operations Centre', is scored at level 2, indicating limited functionality. This confirms the entity’s recognition in the evaluation framework (p. 31). ⁴⁷⁶ Furthermore, the National Action Plan for Health Security (NAPHS 2019–2021) contains direct references to a PHEOC, stating that "a Public Health Emergency Operations Centre (COUS) is being equipped" (p. 15) and "it is not functional" (p. 21). ⁴⁷⁷

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no evidence that the Public Health Emergency Operations Centre (COUSP) is required to conduct a public health emergency exercise at least once a year, nor that it actually does so. No information on this topic is available on the websites of the Ministry of Health ⁴⁷⁸ or the World Health Organization (WHO)⁴⁷⁹ . There are also no scientific or press articles on this topic. Law No. 2020-37 of 3 February 2021 on the protection of human health in the Republic of Benin ⁴⁸⁰ does not explicitly stipulate that the COUSP must conduct an annual exercise in the event of a public health emergency. However, it establishes a framework for health emergency management involving the creation of structures and mechanisms for preparing for and responding to public health emergencies. While the law does not specify the frequency of these exercises, WHO documents recommend that countries conduct them regularly to test COUSP functionality ⁴⁸¹. Notably, a functional simulation exercise was conducted in December 2022 in the African region to test the functionality of COUSPs. However, Benin did not participate⁴⁸² . Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, explicitly references a Public Health Emergency Operations Centre (PHEOC, also known as a HEOC) within the 'Health Emergency Management' technical area. Specifically, indicator R.1.2, 'Public Health Emergency Operations Centre', is scored at level 2, indicating limited functionality but does not confirm that it is required to conduct regular exercises. ⁴⁸³ Furthermore, the National Action Plan for Health Security (NAPHS 2019–2021) contains direct references to a PHEOC, stating that "a Public Health Emergency Operations Centre (COUS) is being equipped" (p. 15) and "it is not functional" (p. 21). ⁴⁸⁴

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no public evidence that the Beninese Emergency Operations Centre (COUSP) conducted a coordinated emergency response or emergency response exercise within 120 minutes of identifying a public health emergency/scenario in the past year. No information on this topic is available on the websites of the Ministry of Health ⁴⁸⁵ or the World Health Organization (WHO) ⁴⁸⁶. There are also no scientific or press articles on this topic. Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, explicitly references a Public Health Emergency Operations Centre (PHEOC, also known as a HEOC) within the 'Health Emergency Management' technical area. Specifically, indicator R.1.2, 'Public Health Emergency Operations Centre', is scored at level 2, indicating limited functionality but does not discuss specific coordinated response times. ⁴⁸⁷ Furthermore, the National Action Plan for Health Security (NAPHS 2019–2021) contains direct references to a PHEOC, stating that "a Public Health Emergency Operations Centre (COUS) is being equipped" (p. 15) and "it is not functional" (p. 21). ⁴⁸⁸

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no public evidence to indicate that an exercise or simulation involving Beninese public health, animal health, national security, or private sector authorities has been organized and focused on a bioterrorism scenario. No information on the subject was found on the official websites of the Beninese Ministry of Health ⁴⁸⁹ , The Ministry of Agriculture ⁴⁹⁰ and World Health Organization (WHO) ⁴⁹¹. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, ⁴⁹²⁴⁹³ and the National Health Security Action Plan (NHSAP / 2019-2021) ⁴⁹⁴ also make no mention of such an exercise. There is also no information on this subject in the National Health Development Plan (NHDPSs / 2018-2022) ⁴⁹⁵ and REDISSE documents. ⁴⁹⁶ All documented exercises mainly concern natural threats, with no explicit mention of intentional or malicious risk, and no reports of these exercises are publicly available. No memorandum of understanding, operational standard, intersectoral guide, or public directive has been identified as explicitly dedicated to coordination between different ministries (public health, animal health, security, private sector) in the event of an intentional biological attack. The existing documents as the National Health Security Action Plan (NHSAP / 2019-2021) and the National Health Development Plan (NHDPSs / 2018-2022) mainly deal with natural emergencies and do not formally cover deliberate acts. ⁴⁹⁷⁴⁹⁸

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Benin has a structured framework for risk communication in the event of a public health emergency that is integrated into several national strategic documents. Notably, the National Health Development Plan (NHDP) for 2018–2022 emphasises the importance of transparent, multisectoral communication for health emergency management. The health development plan cites risk communication as one of the strategic axes used during the COVID-19 crisis: "The strategic axes of the response are: i) coordination; ii) risk communication and; iii) surveillance and investigation; iv) management; v) infection prevention and control; vi) logistics; vii) vaccination and continuity of essential services". (p43-44). ⁴⁹⁹ The 2024–2030 National Health Development Plan (NHDP) is not yet publicly available. The Ministry of Health's 2019–21 National Health Security Action Plan (NHSAP) ⁵⁰⁰ includes risk communication as part of the 'Response' section (p25,p119). This involves targeted information campaigns, community-level relaying of information, and the mobilisation of local and regional structures to disseminate messages in the event of a health crisis. Moreover, the Joint External Evaluation report of 2017 (JEE) states that " During health crises, Benin has the capacity to set up an entity responsible for communication. In most cases, information is disseminated in the local languages" (p. 37). ⁵⁰¹ There is no detail, however, of precisely how this will be effected. Moreover, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "in terms of risk communication, skills exist across Benin, but there is no mapping of risk communication stakeholders and collaboration with communities and influencers." (p54). ⁵⁰² Additionally, the government of Benin has launched the Cooperation Strategy 2023-2027 with the World Health Organization (WHO), which focuses on strengthening preparedness and response to health emergencies. ⁵⁰³ The strategy emphasises the importance of effective communication in emergencies and of disseminating reliable and timely information to prevent the spread of misinformation⁵⁰⁴⁵⁰⁵. These documents also draw on international recommendations, such as those of the World Health Organization (WHO), regarding public health risk communication. ⁵⁰⁶

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

The risk communication plan (or other legislation, regulation or strategy document used to guide national public health response) does not outline how messages will reach populations and sectors with different communications needs (eg different languages, location within the country, media reach, vulnerable groups and hard-to-reach groups). The Ministry of Health's 2019–21 National Health Security Action Plan (NHSAP) ⁵⁰⁷ includes risk communication as part of the 'Response' section (p25,p119). This involves targeted information campaigns, community-level relaying of information, and the mobilisation of local and regional structures to disseminate messages in the event of a health crisis. The stakeholder engagement plan associated with the World Bank's project on the Coronavirus Disease 2019 (Covid-19) ⁵⁰⁸ explicitly provides for collaboration with organisations working with people with disabilities to develop suitable messages, the creation of local messages in national languages, and raising awareness in remote areas. The Joint External Evaluation report of 2017 (JEE) states that " During health crises, Benin has the capacity to set up an entity responsible for communication. In most cases, information is disseminated in the local languages." (p37) There is no detail, however, of precisely how this will be effected. ⁵⁰⁹ Moreover, the 2023 JEE states that "in terms of risk communication, skills exist across Benin, but there is no mapping of risk communication stakeholders and collaboration with communities and influencers." (p54). ⁵¹⁰ This indicates that the authorities are planning to address different communication needs, particularly with regard to geographical location, accessibility (disability) and languages used. However, no formal national legal document yet fully details these multilingual and group-specific mechanisms.

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 100

This risk communication plan, or any other legislative, regulatory or strategic document used to guide the national public health response, designates a specific government position that will serve as the primary public spokesperson in the event of a health emergency. The National Action Plan for Health Security 2019–2021 (NAPHS) ⁵¹¹ provides for the appointment of an official spokesperson to handle public communications in the event of a health emergency (p122). According to the Beninese governement, the World Health Organization (WHO) and the assessments "Benin unveils its new health strategy" (2024) and "Covid-19 in Benin: Government faces press after 'urgent' measures" (2019), this role is currently assigned to the Minister of Health, who designates a representative to act as the primary spokesperson in the event of a health emergency. Currently, Professor Benjamin Hounkpatin holds this role, supported by the Deputy Secretary-General of the Government, Wilfried Léandre Houngbédji, who also serves as government spokesperson ^{512513514515516}. According to the assessment "Covid-19 in Benin: Government faces press after 'urgent' measures" (2019), in the event of a health crisis, Professor Hounkpatin is responsible for technical and health communication, while Mr Houngbédji coordinates general government communication. This organisation was evident during joint press conferences, notably in September 2021, when urgent measures to combat the pandemic were announced.⁵¹⁷ In line with the recommendations of the World Health Organization (WHO), the regulatory framework of Benin's Ministry of Health emphasises the importance of centralised and transparent communication for the effective management of information. ⁵¹⁸

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 50

Over the past year, the public health system has used online media platforms (e.g. social media and websites) to share messages and keep the public informed about current health concerns, as well as dispelling rumours and misinformation, but only during active emergencies and does not regularly utilize online media platforms. The Ministry of Health's website has an 'Informations' tab, through which it regularly keeps the public informed of its various developments via news and press releases^519520521. Furthermore, according to the newspapper Le Matinal, the Ministry of Public Health organised capacity-building workshops for media professionals in collaboration with partners such as the Regional Project for Strengthening Disease Surveillance Systems in Benin (Redisse). These workshops aimed to improve understanding of epidemics and public health emergencies, enabling journalists to better grasp and communicate these sensitive subjects. The objective was to train the media to effectively relay information, thereby contributing to better communication with the public during periods of public health crisis. ⁵²² Additionally, the government of Benin has launched the Cooperation Strategy 2023-2027 with the World Health Organization (WHO), which focuses on strengthening preparedness and response to health emergencies. ⁵²³ The strategy emphasises the importance of effective communication in emergencies and of disseminating reliable and timely information to prevent the spread of misinformation. ⁵²⁴⁵²⁵

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence that senior leaders, such as the president or ministers, have shared misinformation or disinformation about infectious diseases in Benin over the past two years. Although there is no legislation in Benin to counter disinformation, Law N° 20-2017 of 20 April 2018 on the digital code, through article 550, does include strict restrictions on the dissemination of false information: "Anyone who initiates or relays false information against a person by means of social networks or any form of electronic support shall be punished by imprisonment for one (01) month to six (06) months and a fine of five thousand (500,000) CFA francs to one million (1,000,000) CFA francs, or one of these penalties alone". ⁵²⁶⁵²⁷. There is no evidence of this subject in national media, on government websites such as those of the Presidency ⁵²⁸ and the Ministry of Health ⁵²⁹, or from regulatory and fact-checking bodies. ⁵³⁰

3.6.1a Percentage of households with Internet

Score: 36.84

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 62.75

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 43.33

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 0

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

Over the past year, Benin didn't impose restrictions on the export of certain medical products, due to an infectious disease outbreak. The information available on the websites of the Benin Ministry of Health ⁵³¹ , the World Trade Organization (WTO) ⁵³² , Global Trade Alert ⁵³³ , and Africa for Investors ⁵³⁴ does not mention any such measures related to an epidemic or pandemic. According to the Organisation for Economic Co-operation and Development – OECD Health Policy Studies assessement entitled "Securing Medical Supply Chains in a Post-Pandemic World" (2024), during the COVID19 pandemic, the country imposed restrictions on the export of certain medical products, primarily due to disruptions in global supply chains caused by the ongoing pandemic. These measures were aimed at securing the national supply of personal protective equipment (PPE), medicines, and other essential medical supplies. ⁵³⁵ According to the article "Covid-19: Benin ranked 13th in the fight against counterfeit medicines" (2020), the Beninese authorities collaborated with international partners, such as the World Customs Organization (WCO), to combat the illicit trafficking of these products. ⁵³⁶ These restrictions were based on international recommendations and structured decision-making mechanisms. In particular, the World Customs Organization coordinated Operation STOP, which mobilized 84 customs administrations, including Benin's, to combat the illicit trade in medicines and medical supplies related to COVID-19 (section "Results") ⁵³⁷ . Benin thus acted in accordance with international guidelines to protect its population and ensure access to essential medical products.

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no public evidence to indicate that any specific restrictions on the export or import of non-medical products (such as food or textiles) were imposed in 2024 by Benin in response to the outbreak of an infectious disease. The information available on the websites of the Benin Ministry of Health ⁵³⁸, the World Trade Organization (WTO) ⁵³⁹, Global Trade Alert ⁵⁴⁰, and Africa for Investors ⁵⁴¹ does not mention any such measures related to an epidemic or pandemic. No such intervention was identified in 2024. General measures or restrictions on the import of certain products outside of an emergency medical context are indeed mentioned in trade regulations (for example, authorisations for certain strategic products), but none of these relate specifically to the response to an epidemic in 2024–2025. ⁵⁴² Benin applies general import controls, such as product registration, permits, sanitary certificates and one-stop customs clearance, to specific categories, especially pharmaceuticals, medical devices, food, chemicals and petroleum. Medicines and medical products must be registered with the national regulator (ABREP/FDA-Benin) prior to importation. Importers must present invoices, origin attestations, and health certificates for clearance. Certain 'strategic' goods (such as refined petroleum products) require an import/distribution licence issued by the Ministry of Commerce. These measures aim to protect public health and safety, ensure product quality and traceability, and enforce sanitary and phytosanitary rules. ⁵⁴³⁵⁴⁴ Therefore, there is no basis based on international recommendations or a structured decision-making mechanism involving specific scientific evidence, expert input, and guidelines/policies.

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

Benin has not implemented inbound or outbound travel restrictions due to an infectious disease outbreak during the past year. No measures related to a new health threat have been identified in official documents or the most recent travel advisories. There is no evidence to contradict this information on the Benin Ministry of Health website ⁵⁴⁵. In addition, the Belgian government indicates that no COVID-related restrictions are in place for Benin (May 2025) ⁵⁴⁶. The TravelBans organization also confirms that there have been no mandatory tests or vaccinations for travel to Benin since March 2023 ⁵⁴⁷. No interventions have been reported. There are no decisions based on World Health Organization (WHO) recommendations, expert advice, or formalized scientific policies regarding international travel restrictions ⁵⁴⁸. There are no official documents from Benin’s Ministries or similar bodies which state that no travel restrictions were put in place in response to infectious disease outbreaks in 2024–25. However, travel resources confirm that there are currently no inbound or outbound health-related travel restrictions in place. E-Visa Express, a reputable travel service platform, reports that Benin lifted all entry measures related to the SARS-CoV-2 virus in July 2022, and currently imposes no testing, vaccination or quarantine requirements. ⁵⁴⁹

3.7.2b Risk-based approach to international travel-related measures

Score: 0

There is insufficient evidence that Benin uses a risk-based approach to international travel-related measures. According to the criteria of the IHR (2005) ⁵⁵⁰⁵⁵¹ and assessed via the State Party Self-Assessment Annual Reporting Tool (SPAR) ⁵⁵² and the 2017 Joint External Evaluation ⁵⁵³, Benin has limited capacity to implement a risk-based approach to international travel measures. According to this criteria, Benin's capacity to apply a multisectoral approach based on travel risk assessment is classified as Level 1 (limited capacity). Mechanisms for strategic planning, risk assessment, intersectoral coordination and operational procedures are either under development or ad hoc and not yet fully operational. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that “Legislation exists with provisions for the provision of health services to sick travellers at ports of entry, during public health events”(p. 58). Nevertheless, there is a lack of infrastructure construction related to this legislation (p. 58). ⁵⁵⁴ The World Health Organization (WHO) Strategic Partnership for Health Security Portal ⁵⁵⁵ for Benin also confirms the lack of mature implementation of this approach. Although the country has conducted several exercises (ATRs and external assessments), there are no formal intersectoral decision-making structures in place for risk-based travel measures. While the foundations exist, no formal or consistent implementation in response to health alerts is currently documented at the national level.

4.1.1a Doctors per 100,000 people

Score: 2.71

4.1.1b Nurses and midwives per 100,000 people

Score: 6.84

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

Benin has a strategy in place to identify and address gaps in its healthcare workforce. However, there is no evidence that it has been renewed in the last five years. This information is not available on the website of the Ministry of Health ⁵⁵⁶, in the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, ⁵⁵⁷ or the National Health Security Plan (NAPHS/2019–2021). ⁵⁵⁸ The 2014–2024 report on human resources for maternal, newborn and child health (HRMNCH) in Benin, developed through a multi-stakeholder technical dialogue, proposes targeted interventions to improve accessibility to, and the quality of, human resources in this area (p11-13). ⁵⁵⁹. Furthermore, it has not been formally updated since 2019. Therefore, it is a strategic framework that is still in effect, rather than a recent update. Nevertheless, the World Health Organization (WHO)-Benin Cooperation Strategy 2023–2027 aims to significantly strengthen human resources in the health sector by identifying shortages and planning their reduction (section "Introduction"). ⁵⁶⁰

4.1.1d Health system capacity for essential health services

Score: 0

Benin does not yet have a healthcare system that is capable of fully providing essential health services. The Ministry of Health website⁵⁶¹, the National Health Development Plans (NHDPs/2018–2022) ⁵⁶² , the National Health Security Plan (NAPHS/2019–2021)⁵⁶³ and the Joint External Evaluation (JEE/2017) ⁵⁶⁴ all contain no information on this subject. In 2019, the country's service coverage index (UHC-World Health Organization) stood at 38/100. This figure has remained stable for several years ⁵⁶⁵. The index considers reproductive healthcare, disease prevention and management of non-communicable diseases, as well as access to services ⁵⁶⁶⁵⁶⁷. Benin's score places it among the lowest-performing countries in West Africa, well below the regional average of 40 ⁵⁶⁸⁵⁶⁹. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that, "the absence of guidelines for the continuity of essential health services in the event of a health emergency" (p. 9). In addition, benchmark R3.2 “Use of health services” has a score of 1 (p6). The priority measures to be implemented are as follows: "Review, evaluate, and regularly update clinical case management guidelines to incorporate other priority health events, including chemical and radiological emergencies. Develop continuity of care guidelines for emergency situations. Extend the implementation of the Human Capital Development Insurance program throughout the country to increase the use of health services, particularly during health crises. Equip all departments with epidemiological treatment centers." Furthermore, according to the World Bank "UHC service coverage index – Benin" and the World Health Organization "UHC-indicators", public health spending is very low. It represents around 2.6% of government expenditure. Conversely, direct out-of-pocket medical expenses account for approximately 60% of total health expenditure, indicating significant financial exposure for households ⁵⁷⁰⁵⁷¹. Benin has an extremely low doctor-to-population ratio of 7 doctors and 2 nurses per 10,000 people.This limits the practical capacity of the system. Nevertheless, recent initiatives, such as the ARCH programme (Insurance for strengthening human capital) and the Program-for-Results (PforR) project, are improving financial access and operational capacity. By 2025, it is projected that 6.9k more people in Benin will enjoy better health and wellbeing than in 2018, with a range of 572.9k to 581k . However, it's still insufficient to meet current UHC standards.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

Benin does not have a national plan in place to ensure the continuity of essential health services in the event of a health emergency. Although structured institutional frameworks exist, no public document confirms the existence of a formal plan for ensuring the continuity of essential health services in the event of a health emergency. The Ministry of Health website⁵⁷², the National Health Security Plan (NAPHS/2019–2021) ⁵⁷³ and the Joint External Evaluation (JEE/2017) ⁵⁷⁴ all contain no information on this subject. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that there is an "absence of guidelines for the continuity of essential health services in the event of a health emergency" (p. 9). ⁵⁷⁵ While the country has established a Health Emergency Operations Centre (HEOC) ⁵⁷⁶, as outlined in the national strategic plan, no detailed operational plan ensuring continuity of care is available. While the HEOC is referenced in national documents as the entity responsible for coordinating health emergencies, no operational plan specifically addressing continuity of services in crisis situations is accessible. Furthermore, while the National Health Development Plan (NHDP 2018–2022) ⁵⁷⁷ focuses on emergency preparedness and health system strengthening, it does not explicitly describe continuity mechanisms. The plan, which is available via the World Health Organization (WHO), only sets out broad guidelines for strengthening the healthcare system. A WHO document recommends that health emergency plans include this element, yet no Beninese document mentions any formal implementation (IHR benchmark WHO 14.2).

4.1.2a Hospital beds per 100,000 people

Score: 7.09

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

Benin has limited capacity to isolate patients with highly communicable diseases. There is no evidence to the contrary on the websites of the Ministry of Health ⁵⁷⁸ or the National University Hospital Centre – Hubert Koutougou Maga (CNHU-HKM) ⁵⁷⁹. Benin's 2017 Joint External Evaluation (JEE) ⁵⁸⁰ does not explicitly mention biological isolation units or rooms dedicated to these diseases. However, several factors suggest the presence of structural gaps in this area. In particular, it suggests that hospital facilities, laboratories and alert systems lack specialised equipment or protocols for the safe management of transmissible pathogens. The the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, mentions that not all hospitals have the capacity to isolate patients with isolation units (p. 51). ⁵⁸¹ The World Health Organization's (WHO) biennial report for 2022–23 (pp. 39-46) and the regional assessment documents entitled "Cholera situation in Benin" (p. 9) and "Possible lassa outbreak in Benin with possible exposure of Belgian citizens" operational responses in 2023, such as activating temporary treatment centres and isolation wards to manage cholera and Lassa fever outbreaks. The detection of potential Lassa fever outbreaks in 2023 necessitated the transfer of patients and the establishment of local isolation units^582583584 . These documents demonstrate ad hoc mobilisation and surge capacity, rather than the creation of permanent 'high-security' units. According to the assessments named "Determinants of SARS-CoV-2 infection across three sentinels sites in Benin during 2021: A multicentric surveillance study" (2025) and "Benin responds to covid-19: sanitary cordon without generalized containment or lockdown?" (2020), during the 2020–21 SARS-CoV-2 pandemic, a cordon sanitaire was established between March and May, and supervised quarantine measures helped contain community cases. ⁵⁸⁵⁵⁸⁶ Nevertheless, the country continues to suffer from insufficient health infrastructure, including a limited number of hospital beds and specialised equipment, which restricts the provision of dedicated biological isolation units ⁵⁸⁷⁵⁸⁸. Reports from the World Bank and the WHO describe the creation of treatment and isolation centres, including the Allada Epidemic Treatment Centre, as well as five treatment centres and 89 screening sites, during the period of the pandemic. ⁵⁸⁹⁵⁹⁰ And, UNICEF situation reports document the large number of people who were quarantined and the contact-tracing activity that took place in the early stages of the pandemic. ⁵⁹¹

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 100

Over the past two years, Benin has demonstrated its ability to increase its isolation capacity ad hoc in response to infectious disease outbreaks. The World Health Organization's (WHO) biennial report for 2022–23 (pp. 39-46) and the regional assessment documents entitled "Cholera situation in Benin" (p. 9) and "Possible lassa outbreak in Benin with possible exposure of Belgian citizens" operational responses in 2023, such as activating temporary treatment centres and isolation wards to manage cholera and Lassa fever outbreaks. The detection of potential Lassa fever outbreaks in 2023 necessitated the transfer of patients and the establishment of local isolation units. ^592593594 These documents demonstrate ad hoc mobilisation and surge capacity, rather than the creation of permanent 'high-security' units. Evidence shows that the country has developed, updated or tested a plan to increase its isolation capacity in response to an infectious disease outbreak over the past two years. In 2023, the WHO and the Beninese government produced operational documents and a cooperation strategy (WHO-Benin CCS 2023–2027, "introduction" section) ⁵⁹⁵⁵⁹⁶, which includes plans to strengthen preparedness and address multiple risks.

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

Benin has a national regulatory framework for procuring laboratory supplies and medical equipment under public contracts. The revised 2020 Public Procurement Code ⁵⁹⁷ governs all public procurement, including medical supplies, laboratory equipment, and personal protective equipment (PPE). The Code applies to all public entities, including ministries. This includes the Ministry of Health, which is responsible for purchasing medicines and equipment, and the Ministry of Agriculture, which is responsible for acquiring veterinary, laboratory and phytosanitary analysis equipment. ⁵⁹⁸ The Public Procurement Regulatory Authority (ARMP) oversees all public procurement and the promulgation of reliable contractual protocols. ⁵⁹⁹ Additionally, the SIAPS programme (USAID), ⁶⁰⁰ which conducted a national assessment of the health products supply chain in 2018, identified issues with quantification, procurement and inventory practices and formulated a strategic plan to address these. The Benin Food and Drugs Administration (FDA), an official Beninese entity responsible for regulating the quality of food, cosmetic, pharmaceutical and chemical products, publishes guidelines for the import, registration and quality control of medical and biological products, including those for laboratories. ⁶⁰¹ At an international level, Benin collaborates with partners such as Economic Community of West African States (ECOWAS), the World Health Organization, the Food and Agriculture Organization, of the United Nations (FAO) ⁶⁰², USAID ⁶⁰³ to facilitate joint supply purchases by ministries. However, not all specific contractual protocols are publicly available. Moreover, there is clear evidence of public tenders in Benin specifically for laboratory and medical supplies procurement: a 2019 tender invited bids for laboratory supplies (blood grouping sera, test kits, pipette tips) for the National Public Health Laboratory. (Direction Nationale de Contrôle des Marchés Publics, Tender Notice 2019) and a recent ICB procurement plan (deadline January 2025) includes laboratory consumables, essential drugs, and equipment, with a value estimated at around 36 million$. ⁶⁰⁴ Benin has national standards and structured procurement mechanisms, as well as legal and operational support for purchasing medical and laboratory supplies.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no evidence that Benin has a stockpile of medical supplies (disease control measures, medicines, vaccines, medical equipment, or personal protective equipment) for use at the national level in the event of a public health emergency, as defined in the national health emergency response plan or in a plan to ensure equitable distribution in the event of an emergency. Although Decree No. 2023-334 establishes procedures for managing health emergencies and disasters, it does not define a physical stockpile or a specific national distribution system ⁶⁰⁵. No national directive, law or public document specifies a structured plan for the equitable distribution of supplies in the event of a health crisis. Although official plans (National Health Development Plans, National Health Security Action Plan) ⁶⁰⁶⁶⁰⁷ mention emergency response, they do not detail logistical mechanisms to ensure equitable distribution in an emergency. The National Health Security Action Plan ⁶⁰⁸ includes a multisectoral IHR plan focused on prevention, detection and response (pp. 97-99), but makes no explicit mention of a national strategic stockpile or an emergency supply logistics plan. The 2017 Joint External Evaluation report for Benin encourages the establishment of multi-sectoral emergency plans, but does not mention any pre-positioned strategic stock or certified distribution mechanism (p2). ⁶⁰⁹ The same situation is stated in the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023 (pp. 55-56). ⁶¹⁰ Moreover, the World Bank-collaborated-on 'Covid-19 Preparedness and Response Project' outlines the procurement of vaccines, reagents and personal protective equipment (PPE) in the context of the pandemic, but makes no reference to a permanent pre-positioned stockpile or a formally documented equitable distribution mechanism (p. 26). ⁶¹¹ No government, World Health Organization ⁶¹² report confirms the existence of a centralised strategic stockpile of medical or veterinary supplies specifically set aside for a public health emergency as defined in a national response plan.

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no evidence that Benin maintains a stockpile of laboratory supplies, such as reagents or media, for national use in the event of a public health emergency. Although Decree No. 2023-334 establishes procedures for managing health emergencies and disasters, it does not define a physical stockpile or a specific national distribution system⁶¹³. No national directive, law or public document specifies a structured plan for equitably distributing supplies in the event of a health crisis. While official plans such as the National Health Development Plan (NHDP 2018-2022) ⁶¹⁴ and the National Action Plan for Health Security ⁶¹⁵ mention emergency response, they do not detail the logistical mechanisms to ensure equitable distribution in the event of an emergency (p. 22). The 2017 Joint External Evaluation (JEE) ⁶¹⁶ report does not specifically mention laboratory supplies, but indicates that national laboratories face several challenges, including 'frequent stockouts of reagents' (p2). However, 'laboratory capacities were developed with German support; Benin took all necessary measures to facilitate the receipt of laboratory equipment, and this was done without any major problems' (p. 35). The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, includes the problem of 'frequent stockouts of reagents" (p. 29). ⁶¹⁷ According to the third edition (2019) of Benin's IDSR Technical Guide ⁶¹⁸, authorities at all levels are explicitly recommended to establish an emergency stockpile of medicines, vaccines, reagents and laboratory supplies in order to respond quickly in the event of an epidemic (p. 279). However, no public source confirms that this stockpile has actually been established or maintained at the national level. Nor does it specify its volume, exact location, or how it can be activated in an emergency.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence that Benin conducts or requires an annual review of the national stockpile to ensure its adequacy for a public health emergency, nor that stockpiles are available. The Ministry of Health's website contains no such information ⁶¹⁹. The 2017 Joint External Evaluation (JEE) report does not specifically mention stockpiles or annual reviews. However, it does state that 'Benin lacks a national plan for the transfer of medical countermeasures, deployment of health workers and reception of medical supplies in the event of an epidemic or pandemic' (p. 2). It recommends developing 'a specific national plan for the reception of medical supplies to deal with a possible epidemic or pandemic' (p35). ⁶²⁰ The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that there is a problem of 'frequent stockouts of reagents" (p. 29). ⁶²¹ The 2019 SIMR Guide recommends establishing and managing emergency stocks of reagents and supplies, including inventory management, monitoring expiration dates, and replenishment. However, it does not prescribe a codified annual review. (p279) ⁶²² The 2017 cholera containment plan reports frequent reagent shortages at the national laboratory, highlighting deficiencies in stock management operations but does not mention a stockpile or reviewing its contents annually(p26). ⁶²³ No other articles or studies were found to suggest that Benin has access to a stockpile or that an annual review would be required.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is no publicly available evidence of a formal plan or agreement to manufacture medical supplies (medicines, vaccines, PPE and equipment) using national or regional production during a health emergency. The Ministry of Health website ⁶²⁴, the 2019-2021 National Health Security Action Plan ⁶²⁵ and the World Health Organization (WHO) ⁶²⁶ website all contain no information on this matter. The country has an organisation called SoBAPS SA (formerly CAME) ⁶²⁷ that is responsible for centralising the procurement of essential health products. However, no explicit protocol requiring emergency procurement for national use is mentioned in any public policies. There is also no information on the Beninese Ministry of Health website ⁶²⁸, in the National Action Plan for Health Security 2019-2021 ⁶²⁹ or on the World Health Organization website ⁶³⁰, regarding a formal or expedited mechanism for transporting medical supplies to borders or ports in the event of a health emergency.

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no public evidence of a plan or agreement to utilise national (including regional) public and/or private sector production capacity to manufacture laboratory supplies (reagents and culture media) for domestic use in the event of a public health emergency. Neither the Ministry of Health website ⁶³¹ nor the National Action Plan for Health Security (NAPHS/2019-2021) ⁶³² contain any information on this topic, nor does the World Health Organization (WHO) ⁶³³ website. While the National Health Development Plan (NHDP/2021–2025) ⁶³⁴ encourages the promotion of local production of generic medicines, no specific plan is mentioned for the production of reagents or culture media in emergency situations. Similarly, there is no evidence of a plan or mechanism for purchasing laboratory supplies for national use in the event of a health emergency. The Ministry of Health website ⁶³⁵ , the National Health Development Plan (NHDP/2021–2025) ⁶³⁶ , the National Health Security Plan (NAPHS/2019–2021) ⁶³⁷ and the WHO website ⁶³⁸ contain no information on this subject. The REDISSE-Benin project includes a 'laboratory capacity building' component with mechanisms for the rapid supply of reagents and equipment during a crisis ⁶³⁹ . However, this is not a clearly established permanent national protocol. None of the aforementioned sources mention an official mechanism for the priority delivery of laboratory supplies to points of entry in the event of a health emergency.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

There is evidence of a published national and subnational system for emergency logistics and supply chain management in Benin. During the COVID-19 pandemic, Benin has implemented digital tools that can be used as a logistics mechanism. ⁶⁴⁰ In addition, with the help of the World Bank and UNICEF, they have set up a supply chain system for vaccination. (p13;p21) ⁶⁴¹. Benin has a strengthened national logistics system, particularly through the eLMIS tool deployed via USAID since 2021, which facilitates stock management and the ordering and tracking of medicines and supplies in several health zones. ⁶⁴² A 2018 SIAPS evaluation confirmed the existence of a national plan to improve the supply chain for essential health products. ⁶⁴³ This system has been partially tested, examined, evaluated and updated. Initiatives such as the GHSC-TA Francophone project (through USAID) include the development of an 'Emergency Supply Chain Playbook', which has been tested in various African countries in collaboration with national authorities. ⁶⁴⁴ However, there is no public evidence of a specific, regularly documented national programme in Benin. The system covers specific aspects, such as the management of the cold chain for vaccines. The LOGIVAC+ project in Ouidah trains cold chain managers to improve immunisation logistics and cold chain maintenance. ⁶⁴⁵

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no primary source evidence that Benin has guidelines for the distribution of medical countermeasures (MCMs) for use within the country in the event of a health emergency, including antibiotics, vaccines, therapeutics and diagnostics. No information on this is available on the websites of the Ministry of Health ⁶⁴⁶ or the Institute of Public Health. ⁶⁴⁷ Nevertheless, according the World Health organization, Benin is developing frameworks for the distribution of MCMs in emergencies. According to indicator 12A.5 of the WHO-IHR framework, countries are expected to develop a national operational plan to mobilise, receive, store and deploy MCMs with specific protocols and logistical arrangements. ⁶⁴⁸ According Strategic Partnership for Health Security Portal, Benin's preparedness profile includes the theme 'Medical Countermeasures and Personnel Deployment', which confirms that such mechanisms are recognised and supported at a strategic level. While no specific Beninese legislation is referenced, these sources demonstrate that Benin possesses national guidelines aimed at organising the distribution of these countermeasures in the event of a health emergency. ⁶⁴⁹

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no public evidence that Benin has a public plan to increase its healthcare workforce in the event of a health emergency. Neither the Ministry of Health website ⁶⁵⁰ nor the World Health Organization (WHO) ⁶⁵¹ website contains any information on this topic. However, the National Action Plan for Health Security (NAPHS/ 2019-2021), developed by the Ministry of Health, includes the following specific action: "Develop a plan to increase staffing levels in line with needs; implement the plan to increase staffing levels" (p116). These are mostly general directives, with no specific details on modalities or resources. It is a framework directive that commits to developing a concrete plan. ⁶⁵² The National Health Development Plan (NHDPs/2018–2022) emphasises the need to develop human resources for health, particularly by adapting staffing levels to the needs of health facilities (p. 38). It identifies "insufficient qualitative and quantitative human resources in health" as a major constraint (p. 24). It calls for staffing levels to be adapted to meet the needs of facilities, for pre-service and in-service training to be strengthened, and for retention in underserved areas to be improved. The document does not contain a detailed plan, but rather a general strategy for developing staff capacity. ⁶⁵³ While the documents provide guidance and actions to be implemented, they do not always contain a detailed or prescriptive plan.

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence of a plan to receive healthcare professionals from other countries in the event of a public health emergency. No law, decree, ministerial directive or international cooperation document in Benin outlines a formalised arrangement for this purpose. No such evidence could be found on the Ministry of Health's website ⁶⁵⁴ or in the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023. ⁶⁵⁵ While the 2017 Joint External Evaluation (JEE) report states that a strength is "good experience of collaborating with international partners to receive international health personnel", there is no evidence of a public plan for this (p. 36). The existing national disaster relief plan 'does not include procedures to mobilise personnel regionally or internationally' (p. 36). ⁶⁵⁶ The WHO-Strategic Partnership for Health Security portal does not indicate any capacity or protocol for accepting international medical personnel in crisis situations. ⁶⁵⁷

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no evidence that Benin has a public plan for redeploying health personnel, nor that this redeployment involves geography or roles. The Ministry of Health website⁶⁵⁸, the National Health Development Plan (NHDP/2018–2022)⁶⁵⁹, the National Health Security Plan (NAPHS/2019–2021)⁶⁶⁰, the 2017 Joint External Evaluation (JEE/2017, which was used to develop the NAPHS)⁶⁶¹, the 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, ⁶⁶² and the World Health Organization (WHO) website contain no information on this subject. However, the National Health Development Plan (NHDP/2018–2022)⁶⁶³ includes the will of the development and implementation of a personnel redeployment plan for all categories in its section dedicated to human resources for health (strategic direction OS3, p. 36). This redeployment concerns both the geographic level and the reassignment of tasks according to need. According to the available evidence, the idea of a plan exists, but its operational feasibility has not been proven.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

The Constitution guarantees the right to medical care for all citizens. Article 8 of the 11 December 1990 Constitution (revised in 2019) states the following: ''The human person is sacred and inviolable. The State has an absolute obligation to respect and protect it. It guarantees its full development. To this end, it ensures its citizens equal access to health, education, culture, information, vocational training and employment." ⁶⁶⁴⁶⁶⁵ This constitutional commitment reinforces Benin's commitment to the African Charter on Human and Peoples' Rights, which was ratified in 1986 and also recognises the right to health as fundamental. The State is obliged to ensure this right is realised ⁶⁶⁶⁶⁶⁷. Moreover, there is no evidence of a guaranteed free's medical care. There is evidence of a program named ARCH that guarantees free care to poor people but not all citizens. ⁶⁶⁸

4.4.1b Access to skilled birth attendants (% of population)

Score: 72.06

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 94.53

4.4.1d Coverage of essential health services through universal health coverage

Score: 22.92

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 38.75

4.4.1f Rate of mortality amenable to health care

Score: 76.76

4.4.2a Guaranteed paid sick leave

Score: 100

Beninese workers are entitled to paid sick leave. They can take time off for mental or physical health issues. This is governed by Law No. 98-004 of the Beninese Labour Code ⁶⁶⁹⁶⁷⁰ and the Beninese General Collective Labour Agreement, available on The Ministry of Labor and Social Affairs website ⁶⁷¹. According to Article 38 of the Labour Code, available on the National Assembly website ⁶⁷²⁶⁷³, an employee with less than 12 months of seniority will receive full salary for the duration of the notice period (short period); one with more than 12 months' service will receive a full salary for three months, followed by half pay for the subsequent three months and one with more than five years will receive full salary for six months. If multiple leave periods occur, the total duration cannot exceed the stipulated period. Article 39 of the Labour Code ⁶⁷⁴⁶⁷⁵ also provides for long-term paid leave (at least six months at full pay) for certain serious illnesses, including mental health conditions, tuberculosis, cancer, and AIDS.

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no evidence that Beninese government has implemented policies and strategic plans to ensure the protection and care of healthcare workers in the event of illness contracted during health emergency response. Law No. 2020-37, passed on February 3, 2021, focuses on protecting human health in Benin and includes rules about workplace safety and health. While it doesn’t specifically mention healthcare workers in emergencies, it sets a broad framework for protecting all workers’ health, which naturally covers healthcare staff. ⁶⁷⁶ Benin’s National Health Policy for 2018–2030 highlights the importance of keeping healthcare workers safe. It states that the government must provide a safe work environment, including preventing job-related risks and managing any illnesses connected to their work. ⁶⁷⁷ The National Development Health Plan from 2018 to 2022 (NDHP), tackles the health and safety of healthcare workers directly. It outlines steps to build their skills, improve their working conditions, and make sure they get proper care if they fall sick because of their job. It clearly says: “Guarantee the safety and physical well-being of healthcare workers at work” (p. 38). ⁶⁷⁸ This is all about protecting them from the risks of their profession, especially during emergency responses. The plan also stresses the need for ongoing training and raising awareness about the dangers healthcare workers face during health crises. ⁶⁷⁹ While the law establishes a general framework for occupational health and safety, it does not include any specific clauses that guarantee healthcare workers medical treatment or compensation if they contract an illness while responding to an emergency. While the law implicitly covers healthcare workers, it does not explicitly state that treatment or compensation for illness or injury during an epidemic response is guaranteed as part of employment. However, the General Statute of the Civil Service do state that employees who suffer occupational accidents or illnesses are entitled to medical care and compensation, overseen by the Caisse Nationale de Sécurité Sociale (CNSS). While this framework covers healthcare workers by default, it is not specific to epidemic response. ⁶⁸⁰

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is no evidence that a system is in place to enable public health officials and healthcare workers to communicate with each other during a public health emergency. No such system was found on the Ministry of Health's website ⁶⁸¹, the National Health Development Plan (NHDP/2018–2022)⁶⁸², the National Health Security Plan (NAPHS/2019–2021)⁶⁸³ and the World Health Organization (WHO) website ⁶⁸⁴ all still contain no information on this subject. The 2017 Joint External Evaluation report states that communication and coordination between the different stakeholders is insufficient (p. 33). ⁶⁸⁵ The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "the country has set up a functional mechanism to facilitate intersectoral coordination and cooperation during public health emergencies." (p. 8) ⁶⁸⁶ In Benin, we assume that coordination and communication in the event of a public health emergency are primarily the responsibility of the Public Health Emergency Operations Centre (PHEOC), established under the authority of the Ministry of Health. The PHEOC is responsible for centralising information, alerting the relevant parties, and coordinating the response ⁶⁸⁷. However, there is currently no public evidence to confirm this assumption. On 18 January 2023, Benin's Council of Ministers adopted the National Strategy for Artificial Intelligence and Big Data (SNIAM, 2023–2027), which expressly includes the health sector as a key area of focus for digital transformation, leveraging AI and data-driven technologies. Furthermore, Benin has witnessed the development of innovative digital health solutions, such as the mobile-based Digital Health ID system created by Kea Medicals. This system facilitates remote medical consultations, health record portability, and insurance integration, which was particularly critical during the period of the pandemic. ^688689690

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no evidence of a system in place for public health officials and healthcare workers to communicate with each other during a public health emergency. Therefore, there is also no evidence of a system that could encompass healthcare workers in both the public and private sectors. No such system was found on the Ministry of Health's website ⁶⁹¹, the National Health Security Plan (NAPHS/2019–2021)⁶⁹² and the World Health Organization (WHO) website ⁶⁹³ all still contain no information on this subject. The 2017 Joint External Evaluation report states that communication and coordination between the different stakeholders are insufficient (p. 33). ⁶⁹⁴ The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "the country has set up a functional mechanism to facilitate intersectoral coordination and cooperation during public health emergencies." (p. 8) ⁶⁹⁵ The National Health Development Plan 2018-2022 emphasises the importance of strengthening the partnership between the public and private sectors, particularly at the health zone level (p. 30;p. 34). It provides for quarterly exchange frameworks between public institutions, civil society organisations and the private sector, aiming to improve governance and response to health emergencies ⁶⁹⁶. The Plateforme du Secteur Sanitaire Privé (PSSP) (Platform of Private Sanitary Sector), established in 2014, represents private healthcare providers and serves as a single point of contact for the Ministry of Health. It plays a key role in coordinating public health actions, including in emergency situations ⁶⁹⁷⁶⁹⁸. However, it only encompasses the private sector. No further information could be found through a general media search. However, there is currently no public evidence to confirm this assumption. On 18 January 2023, Benin's Council of Ministers adopted the National Strategy for Artificial Intelligence and Big Data (SNIAM, 2023–2027), which expressly includes the health sector as a key area of focus for digital transformation, leveraging AI and data-driven technologies. Furthermore, Benin has witnessed the development of innovative digital health solutions, such as the mobile-based Digital Health ID system created by Kea Medicals. This system facilitates remote medical consultations, health record portability, and insurance integration, which was particularly critical during the period of the pandemic. ^699700701

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no evidence that the national public health system monitors or tracks healthcare-associated infections in healthcare facilities. No such system was found on the websites of the Ministry of Health or the Regional Public Health Institute. ⁷⁰²⁷⁰³ The 2017 Joint External Evaluation (JEE) report ranks the 'Healthcare-associated infection (HCAI) prevention and control programmes' section as '1', indicating that the country lacks capacity in this area (p4). The report also states that the Ministry of Health "has prepared a national action plan for the prevention and control of healthcare-associated infections (HCAIs), which is awaiting approval and funding " (p. 10) ⁷⁰⁴. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "the National Surveillance Plan for Healthcare-Associated Infections is to be drawn up under the supervision of the National Council for Hospital Medicine." (p. 18). ⁷⁰⁵ However, no evidence of such a plan was found until recently. The Five-Year Infection Prevention and Control Plan, launched in March 2025, is a major initiative in this regard. It aims to reduce HAIs in Beninese hospitals by strengthening health facility capacities, improving hygiene practices, and ensuring continuous infection surveillance. Developed with the support of the World Health Organization (WHO) and Médecins Sans Vacances, it involved key stakeholders in the health sector, including hospital managers, academic authorities, and healthcare professionals ^706707708. The plan emphasises the importance of regularly evaluating practices and establishing a system for monitoring care-associated infections, even if the resulting data is not made public. However, based on publicly available information, there is currently no evidence that routine tracking or reporting of HCAIs has commenced since the launch of the plan. ⁷⁰⁹

4.6.1b Infection prevention and control programme

Score: 100

There is evidence of a national infection prevention and control programme is publicly available. The Five Year Plan for Infection Prevention and Control (2024–2028), officially launched on 5 March 2025 in Parakou, aims to reduce healthcare-associated infections in the country's healthcare facilities. It followed a field-based diagnosis of health facilities and consultation with stakeholders. The plan aims to reduce HAIs by emphasising data-driven decision-making and institutional transformation in terms of care quality and patient safety. Rather than being a general health system modernisation strategy, it is a focused, actionable plan with measurable targets.The document is only available on Médécins Sans Vacances' website ⁷¹⁰⁷¹¹. Supported by the Ministry of Health ⁷¹², the World Health Organization ⁷¹³ and Médecins Sans Vacances ⁷¹⁴⁷¹⁵, the plan includes the establishment of a system for evaluating and monitoring practices.

4.6.1c National plan to ensure a safe environment in health facilities

Score: 0

There is no evidence of a nationwide plan to ensure safe healthcare environments. The Ministry of Health website⁷¹⁶, the National Health Development Plans (NHDPs) for 2018–2022 ⁷¹⁷, the National Health Security Plan (NAPHS) for 2019–2021 ⁷¹⁸, the Joint External Evaluation (JEE) for 2017 (which was used to develop the NAPHS) ⁷¹⁹ and the World Health Organization (WHO) website ⁷²⁰ all contain no information on this topic. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "a hospital hygiene policy has been drawn up" but some "national standards and resources for a safe built environment must be defined" (p. 52). ⁷²¹ However, the Five-Year Plan for Infection Prevention and Control (2024–2025) ⁷²²⁷²³, which was officially launched in Parakou on 5 March 2025, is presented as a national strategy in which the Ministry of Health is committed to improving patient safety and the quality of care by preventing healthcare-associated infections. This includes promoting hand hygiene as a key intervention. The document is only available on the Médecins Sans Vacances website. ⁷²⁴⁷²⁵ Supported by the Ministry of Health, the WHO and Médecins Sans Vacances, the plan includes establishing a system for evaluating and monitoring practices in accordance with the National Infection Prevention and Control Policy (2016). ⁷²⁶ Implemented by the WHO in Benin, this policy constitutes the initial strategic framework for the plan. It establishes national standards, objectives, and interventions to strengthen patient safety and hygiene in healthcare settings. However, the cited elements clearly demonstrate the intention and priority areas. These documents do not constitute the plan itself.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

A national requirement for ethical review (by an ethics committee or an institutional review board) must be met before a clinical trial can begin. However, no information could be found on the Ministry of Health's website ⁷²⁷ or in the 2017 and 2023 Joint External Evaluation (JEEs) reports ⁷²⁸⁷²⁹. However, a 2022 study published in BMC Medical Ethics entitled, "Knowledge, opinions and experiences of researchers regarding ethical regulation of biomedical research in Benin: a cross-sectional study", highlights the existence of the National Ethics Committee for Health Research (CNERS), which is responsible for approving research protocols. ⁷³⁰⁷³¹ The CNERS was established by ministerial order No. 11434MS/DC/SGM/CTJ/DRS/SA on 3 December 2007 ⁷³²⁷³³. For example, the aforementioned study was validated under opinion no. 28 on 11 July 2018 and then reapproved under opinion no. 37 on 6 August 2019, thus demonstrating that any clinical research project requires prior ethical authorisation ⁷³⁴. Clinical drug trials and pharmaceutical research are regulated by the National Ethics Committee for Health Research (CNERS), which is part of the Ministry of Health, and overseen by the Directorate of Pharmacy, Medicines and Diagnostic Tests (DPMED). The CNERS ensures ethical compliance, while the DPMED regulates authorisations for the importation, distribution and trials of drugs. No evidence of rules or regulations relating to the committee was found. ⁷³⁵⁷³⁶

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 100

There is evidence of an expedited process for approving clinical trials of unregistered medical countermeasures, of the mutual recognition of clinical trial results conducted elsewhere for the treatment of ongoing pandemics or epidemics. Benin is part of AVAREF. This initiative enables African countries to strengthen their regulatory capacity in the ethical and scientific evaluation of vaccine trials. It facilitates harmonisation, joint assessments and accelerated regulatory approvals. It also promotes regional collaboration and alignment with World Health Organization (WHO) standards. ⁷³⁷ Nevertheless, no national legislation, public guidance or emergency authorisation indicates that any Beninese committee has a formal process for temporarily authorising unregistered medical products in emergency situations. Benin, via the WAEMU (West African Economic and Monetary Union), follows Regulation No. 02/2005/CM/UEMOA for the harmonisation of pharmaceutical control; however, current public texts make no explicit mention of the recognition of evaluations or tests carried out abroad. ⁷³⁸ Clinical drug trials and pharmaceutical research are regulated by the National Ethics Committee for Health Research (CNERS), which is part of the Ministry of Health, and overseen by the Directorate of Pharmacy, Medicines and Diagnostic Tests (DPMED). The CNERS ensures ethical compliance, while the DPMED regulates authorisations for the importation, distribution and trials of drugs. No evidence of rules or regulations relating to the committee was found. ⁷³⁹⁷⁴⁰

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

A government agency is responsible for approving new medical countermeasures (MCMs) for humans. The Directorate of Pharmacy, Medicines and Laboratories (DPMED), which is now part of the Agence Béninoise de Régulation Pharmaceutique (ABRP/FDA-Benin) within the Ministry of Health, is the competent authority responsible for registering medicines, including vaccines, antibiotics and other therapeutic products . According to the African Union Develpment Agency website, one of the roles of this body is to "develop and implement the national logistics system for medicines, medical equipment and consumables, including those related to biomedical analysis laboratories", but there is no specific reference to approving countermeasures for humans. ⁷⁴¹ The Beninese Pharmaceutical Regulatory Agency (ABMed) ⁷⁴², established by Decree No. 2023-422 on 26 July 2023 ⁷⁴³, is responsible for overseeing national pharmaceutical policy, quality control, inspections and logistics for health products. However, it does not make final approval decisions. ABMed includes several technical advisory committees that provide expertise, but the agency remains responsible for final decisions. ⁷⁴⁴⁷⁴⁵ The ABRP/FDA-Benin is responsible for granting marketing authorisations (AMM) for medicines and vaccines, licensing importation and distribution, regulating clinical trials and ensuring pharmacovigilance. The agency is governed by four key pieces of legislation: Law 2021-03 of 1 February 2021, which establishes its role as the regulatory body for the pharmaceutical sector in the Republic of Benin; Law 2020-20 of 2 September 2020, which establishes its role as a public enterprise in the Republic of Benin; and the OHADA Uniform Act, which contains rules of law on commercial companies and economic interest groups. Benin has a clear institutional framework for the approval of MCMs, comprising an official authority competent to issue marketing authorisations and an agency responsible to evaluate and authorize MCMs for human use, whether for medicines, vaccines or diagnostics. ⁷⁴⁶

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no public evidence of an expedited approval process for medical countermeasures (MCMs) intended for human use, nor of the recognition of approval decisions made elsewhere during public health emergencies. The Ministry of Health website⁷⁴⁷, the National Health Development Plans (NHDPs) for 2018–2022 ⁷⁴⁸, the National Health Security Plan (NAPHS) for 2019–2021⁷⁴⁹, the Joint External Evaluation (JEE) for 2017 ⁷⁵⁰ and the World Health Organization (WHO) website ⁷⁵¹ all lack such information. According to the sources above, there is also no public evidence to suggest that Benin has a formal national Emergency Use Authorisation mechanism in place to rapidly validate unregistered medicines, vaccines or diagnostics. The 2nd Joint External Evaluation (JEE) for Benin, conducted between 24 and 28 July 2023, states that "the players involved in the management of medical countermeasures have limited capabilities" (p. 45). ⁷⁵² The Directorate of Pharmacy, Medicines and Laboratories (DPMED), which is now part of the Agence Béninoise de Régulation Pharmaceutique (ABRP/FDA-Benin) within the Ministry of Health, ⁷⁵³ adheres to standard WAEMU (West African Economic and Monetary Union) procedures, which have no known expedited provisions. Although Benin ratified the African Medicines Agency (AMA) treaty in 2021, committing to regional harmonisation, no national legislation stipulates the automatic recognition of authorisations from other agencies. ⁷⁵⁴

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Benin has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁷⁵⁵

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

Epidemics and pandemics are incorporated into the national risk reduction strategy. The Food and Agriculture Organization of the United Nations (FAO) website indicates that Benin has a National Disaster Risk Reduction Strategy (NDRS) covering the period 2019–2030. ⁷⁵⁶⁷⁵⁷ In the health section, it notes that Benin already has a national epidemic response plan and an Integrated Disease Surveillance and Response (SIMD) system aligned with the International Health Regulations (IHR), which covers epidemic-prone diseases and provides an early warning system (pp. 69–70). ⁷⁵⁸ Adopted in accordance with the Sendai Framework, the strategy aims to strengthen resilience to major risks. The strategy explicitly includes epidemics among the considered hazards, alongside floods, droughts, socio-political crises and chemical risks. Key pandemic-related measures include ensuring epidemiological surveillance and early warning systems, preparing and activating contingency plans (such as the 2013 influenza pandemic response plan coordinated by the ANPC and its Centre des Opérations d’Urgence (COU)), strengthening institutional coordination for health emergencies, and incorporating epidemics into multisectoral risk management. ⁷⁵⁹⁷⁶⁰ Therefore, there is no stand-alone strategy dedicated specifically to epidemics or pandemics; these are included in the overall disaster risk reduction strategy. The previous National Contingency Plan (2015) also addresses these threats and incorporates epidemic health crises into its crisis management scenarios. ⁷⁶¹

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

Benin has participated in cross-border public health cooperation agreements and initiatives with neighbouring countries. One example is the tripartite meeting held in Cotonou in December 2016, which brought together representatives from Benin, Nigeria, and Togo. The objective of the meeting was to develop a Memorandum of Understanding (MoU) containing seven standard operating procedures to formalise information sharing and coordination between the countries in the event of a health emergency. ⁷⁶²⁷⁶³ There is no evidence of any other multilateral cooperation agreements in the case of a health emergency. Furthermore, the West African subregion benefits from the cooperation framework established by the West African Health Organisation (WAHO), a specialised agency of the Economic Community of West African States (ECOWAS). WAHO coordinates regional activities such as joint epidemiological surveillance, emergency preparedness, and coordinated responses to health crises ⁷⁶⁴. From 20 to 24 January 2025, WAHO organised a mission to assess Benin's preparedness for and response to the Mpox (monkeypox) epidemic by emphasizing the importance of information sharing, community surveillance, diagnostics and rapid funding in order to reinforce the collective response of member states. Experts collaborated with the Beninese authorities to evaluate the strengths and weaknesses of the national system, and to develop a strategy to enhance regional preparedness for future epidemics. The Regional Centre for Surveillance and Disease Control (RCSDC) in Abuja coordinates cross-border responses and capacity building. ⁷⁶⁵ Additionally, the ECOWAS Assembly of Health Ministers adopted a regional community health policy at its meeting in Praia, Cape Verde, in May 2025, with the aim of improving health systems, resilience to epidemics and strengthening community health systems and coordinate the supply of vaccines and medicines. ⁷⁶⁶

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 100

ECOWAS (the Economic Community of West African States) is a regional organisation created to promote the economic, political and social integration of its member states. Its activities include facilitating the free movement of people and goods, harmonising economic policies, cooperating on peace and security, and launching sectoral initiatives in areas such as health, energy, and trade. ECOWAS also plays a key role in preventing and managing crises in the region. Conversely, programmes run by the ECOWAS, in which Benin participates, include the cross-border management of animal health emergencies. ⁷⁶⁷ While this is a multilateral mechanism, it fulfils the function of an agreement. At the ECOWAS level, the Centre Régional de Santé Animale (CRSA) coordinates the Regional Animal Health Information System (RAHIS), which was deployed in 2024 to strengthen surveillance and information sharing on border animal diseases such as avian influenza. ⁷⁶⁸ Benin is also participating in the GHS-Africa project, which is being piloted by the FAO and USAID via the Emergency Centre for Transboundary Animal Diseases (ECTAD). This programme, launched in 2024, aims to strengthen the capacity of national veterinary services to respond to emerging health threats, zoonoses, and antimicrobial resistance. ⁷⁶⁹

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Benin is a signatory to, and State Party of, the Biological Weapons Convention. According to the United Nations Treaty Secretariat, Benin signed the Convention on 10 April 1972 when it opened for signature in London, Moscow and Washington. It ratified the Convention on 25 April 1975, officially becoming a State Party. ⁷⁷⁰⁷⁷¹ The Arms Control Association also confirms this information, explicitly stating the dates of signature and ratification/accession to the treaty. ⁷⁷²

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

There is no public evidence that Benin has submitted any Confidence-Building Measures (CBMs) under the Biological Weapons Convention (BWC) within the last three years. This is not mentioned on the websites of the Ministry of Health ⁷⁷³, the Ministry of Agriculture, Livestock and Fisheries ⁷⁷⁴, or the Ministry of Foreign Affairs ⁷⁷⁵. The website of the United Nations Office for Disarmament Affairs (UNODA) also shows no evidence of this ⁷⁷⁶. The UN's electronic CBM portal (eCBM), which lists reports submitted by States Parties, shows no recent entries for Benin. ⁷⁷⁷ While UNODA activities in Africa include capacity-building workshops and awareness-raising campaigns in several countries, including Benin in 2023, these do not correspond to an actual CBM submission by the country. ⁷⁷⁸⁷⁷⁹

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Benin provided the report required by United Nations Security Council Resolution 1540 to the Security Council Committee established by said resolution (the 1540 Committee). The 1540 Committee's website confirms the existence of a report provided by Benin in its “National Implementation” annex. ⁷⁸⁰ Furthermore, the 2008 edition of 'Security Council Committee Established Pursuant to Resolution 1540' states that Benin is 'the additional Vice-Chairman of the Committee' and one of the states that have submitted a national report : "States that have submitted a national report and additional information as of 30 April 2006 – States that have submitted a report: 15. Benin”. ⁷⁸¹

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Benin does not meet at least two of the criteria, just one. Such information is lacking on the Ministry of Health website ⁷⁸², Ministry of Defense website ⁷⁸³, in the National Health Security Plan (NHSP) for 2019-2021 ⁷⁸⁴, and on the World Health Organization (WHO) website. ⁷⁸⁵ The Global Partnership (GP) Against the Spread of Weapons and Materials of Mass Destruction and the Australia Group websites lists its member countries, none of which are in Benin. ⁷⁸⁶⁷⁸⁷. Nevertheless, the Nuclear Threat Initiative website states that, in February 2024 in Marrakech (Morocco), Benin officially endorsed the Proliferation Security Initiative (PSI), bringing the total number of participating countries to 111. ⁷⁸⁸

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 100

Benin has carried out a Joint External Evaluation (JEE) over the past five years and has published a full public report. According to the World Health Organization (WHO) – Strategic Partnership for Health Security (SPH) portal, a JEE was conducted in Benin from 24 to 28 July 2023. This evaluation indicates a clear improvement in IHR capabilities compared with the previous evaluation in 2017. The platform indicates the status of this assessment as “Conducted”, confirming that it has been completed. ⁷⁸⁹⁷⁹⁰

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

There is no evidence that Benin has conducted and published a Performance Evaluation of Veterinary Services (PEVS) in the last five years. Neither the Ministry of Health ⁷⁹¹ website nor the National Health Development Plan (NHDP) for 2018–2022 ⁷⁹², nor the National Health Security Plan (PNSS) for 2019–2021 ⁷⁹³ contain such information. The World Organization for Animal Health (WOAH) PVS process consists of an initial assessment and follow-up missions, which are carried out at the request of countries and are publicly reported. Benin has benefited from a follow-up mission, the report of which is available, but it dates from before 2020 (the exact date is not specified, but it predates the requested period) ⁷⁹⁴. The Strategic Partnership for Health Security (SPH) platform of the World Health Organization (WHO) mentions an initial mission for Benin in 2007 and a follow-up report in 2013, but no missions have been recorded since 2020. ⁷⁹⁵⁷⁹⁶ No further information could be found through a general media search.

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

There is no evidence that Benin has conducted and published a gap analysis of the performance of veterinary services (PVS) in the last five years. The Ministry of Health ⁷⁹⁷, the Ministry of Agriculture, Livestock and Fisheries ⁷⁹⁸, the World Organisation for Animal Health (WOAH) website ⁷⁹⁹ and the National Health Development Plans (NHDP) for 2018–2022 ⁸⁰⁰ do not contain any such information either. WOAH reports mention PVS gap analysis missions to other African countries, such as Guinea-Bissau in June 2019, but none of these reports mention Benin during this period. ⁸⁰¹⁸⁰² No further information could be found during a general media search. Benin performed a PVS analysis in 2014 but has not done so since then, according to WOAH. ⁸⁰³

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is no evidence that Benin has allocated domestic funds to improve its capacity to address pandemic or epidemic threats within the past three years. The Ministry of Health website⁸⁰⁴, the National Health Development Plan (NHDP) 2018–2022⁸⁰⁵, the National Health Security Plan (NAPHS) for 2019–2021 ⁸⁰⁶, and the World Health Organization (WHO) ⁸⁰⁷ website all lack such information. However, the government website contains reports indicating a national budget for health and emergency response. In November 2021, the Minister of Health, Benjamin Hounkpatin, proposed a budget of 98.1 billion FCFA (174 million USD) for 2022, representing a 6.7% increase from 2021. Despite it's dated more than three years ago, this funding was aimed at covering the construction of P3-level laboratories, epidemic management and strengthening health personnel and infrastructure in several key cities, among other things; however, this is outside of the 3 year window.⁸⁰⁸

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no evidence the National Action Plan for Health Security (NAPHS) or the GHSA National Roadmap allocate or describe any funding from the national budget to address the identified gaps, either for a future period or within the past five years. However, the 2023 JEE report states that "States Parties shall make available the funds necessary to implement the IHR (in the national budget or via other mechanisms)" (p11). ⁸⁰⁹ Nevertheless, it is a target rather than a capacity of the country. The 2017 JEE report does not indicate the allocation of specific funding in the national budget to address the identified gaps, either in the past or in the future. JEE reports generally highlight areas for improvement, but do not always specify the government's planned funding sources or amounts. The final recommendations of the 2017 JEE call for 'advocating for sustained political and financial commitment from the government', indicating the absence of such commitment in the report (p3). ⁸¹⁰ The 2019–2021 National Action Plan for Health Security (NAPHS) provides no explicit indication of specific national funding planned to address the identified gaps. The NAPHS establishes a strategic roadmap, but does not detail budget amounts. ⁸¹¹ No source mentions direct funding from the national budget under the GHSA roadmap. This suggests an absence of an explicit public budget allocation mechanism under this name.

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no evidence that the Veterinary Services Performance Gap Analysis (PVS) allocates or describes specific funding from the national budget to address the identified gaps, either for a future period or within the past five years. There is also no evidence that Benin has conducted and published a PVS in the past five years. Nor do the Ministry of Health ⁸¹², the Ministry of Agriculture, Livestock and Fisheries ⁸¹³, the World Organisation for Animal Health (WOAH) website ⁸¹⁴, or the National Health Development Plan (NHDP) for 2018–2022. ⁸¹⁵ The PVS Gap Analysis is a planning step that develops a five-year indicative budget to address the identified gaps, which can then be used to seek national and/or external funding. This is not a voted line of credit, but a costed plan. ⁸¹⁶⁸¹⁷ External analysts note that PVS Gap Analysis reports recommend budget increases, but these reports do not constitute an allocation decision by the National Treasury. ⁸¹⁸⁸¹⁹

5.5.3a Emergency public financing during a public health emergency

Score: 100

Emergency public financing mechanisms exist and are specifically identified and accessible in the event of a health crisis. A 2022 study by the International Monetary Fund (IMF) on budget transparency mentions two national instruments: the FNEC (National Fund for the Environment and Adaptation to Climate Change), which is officially intended to respond to natural disasters and epidemics, and is managed through a special allocation account at the Ministry of the Environment. Its budget is modest and is not indexed to a precise risk assessment ; the NDRF (National Disaster Response Fund) is also mentioned, but its specific modalities (amounts, allocation and operation within the public health sector) are not detailed. Benin has formal budgetary mechanisms, but their resources are limited. ⁸²⁰ Additionally, the country has resorted to several rapid financing instruments in the event of a health crisis: the IMF's RFI (Rapid Financing Instrument) and RCF (Rapid Credit Facility) are also used. In December 2020, the IMF provided $178 million to respond to the crisis caused by the SARS-CoV-2 pandemic, complementing previous allocations ⁸²¹ ; the IMF's Resilience and Sustainability Facility (RSF) is another instrument that has been used.In July 2022, Benin received a combined facility totalling around $650 million to help it cope with regional shocks and support its development. ⁸²² In April 2020, the World Bank approved an additional $10.4 million in financing to strengthen preparedness for and response to the pandemic, bringing the total provided through various instruments, including REDISSE, to approximately $40 million. ⁸²³

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

There is no current evidence that any senior leaders (presidents or ministers) have publicly committed to helping other countries improve their capacity to address pandemic or epidemic threats by providing funding or support in the past three years. Neither the Beninese government website ⁸²⁴ nor the Ministry of Health website ⁸²⁵ contain any such information, nor does the World Health Organization (WHO) website ⁸²⁶. No statements from Beninese ministries or official diplomatic information sources report any targeted offers of external health assistance. There is evidence that senior leaders have publicly committed to improving the country's national capacity to address pandemic or epidemic threats by increasing funding or requesting support. But it's dated more than three years ago. The Beninese government website contains reports indicating a national budget for health and emergency response. For example, in November 2021, the Minister of Health, Benjamin Hounkpatin, proposed a budget of 98.1 billion FCFA (174 916 224USD) for 2022, which is a 6.7% increase on the 2021 budget.This funding is intended for strengthening the surveillance system, creating P3 laboratories, and building epidemic centres. ⁸²⁷⁸²⁸.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is no evidence that Benin has provided other countries with financing or technical support in the past three years. However, there is evidence that it has requested financing and technical support from donors to improve its domestic capacity to address epidemic threats. As part of its commitment to combatting HIV/AIDS, tuberculosis and malaria, Benin benefits from 'L'Initiative', a mechanism operated by Expertise France-Fonds Mondial which provides catalytic project financing and technical assistance. This support, which covers the period 2023–2025, aims to complement the country's public health policies. ⁸²⁹ The International Monetary Fund's support programme emphasises Benin's commitment to 'ensuring the sustainable financing of the vaccination programme' through the financial backing of the Global Vaccine Alliance (GAVI). This demonstrates targeted external financing aimed at improving the country's ability to manage epidemic threats, particularly with regard to vaccination. ⁸³⁰

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

There is evidence that Benin has made full contributions to the World Health Organization (WHO) over the past two years. The report on the scale of assessments for 2024–25 indicates that Benin accounts for 0.0050% of the WHO's budget for this period. ⁸³¹ According to the 78th World Health Assembly report (2025), Annex 1, 'Status of collection of assessed contributions as at 31 December 2024', mentions Benin in the 'collected 2024' column. This shows that all the money has been collected and that Benin has fully contributed. Moreover, 152 of the 197 Member States had paid their contributions in full or in part. The overall collection rate is approximately 70%. ⁸³²

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available evidence of a plan or policy for sharing genetic and epidemiological data, or clinical specimens, with international organisations or other countries beyond the scope of influenza. Nor is there any evidence of plans to share such data or specimens with international organisations or other countries beyond the scope of influenza. There is also no evidence of such plans on the websites of the Ministries of Health ⁸³³ or Agriculture, Livestock and Fisheries. ⁸³⁴ No further information on such sharing can be found in the media. However, the May 2017 Joint External Evaluation (JEE) report does highlight that 'if needed, specimens can be sent to laboratories abroad'. Nevertheless, this arrangement does not appear in any publicly available plans and is not explicitly inclusive of pathogens with pandemic potential. ⁸³⁵ Moreover, the JEE 2023 states that "Official agreements have been signed with foreign laboratories to carry out specialized analyses not available in the country" (p33). ⁸³⁶ A comparative review of 22 African countries shows that many states have complex rules governing the storage, export and reuse of samples, as well as informed consent, often on a case-by-case basis. Benin is not, however, cited among the countries with explicit national guidelines or policies in this area. ⁸³⁷ A more global examination reveals a significant regulatory gap at the regional level, particularly with regard to clear directives concerning the export or secondary use of samples, and the governance of informed consent and the inclusion of sensitive genetic data. ⁸³⁸

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 0

Public evidence shows that Benin has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework for the past two years. The PIP framework establishes an obligation for participating countries to share potentially pandemic influenza viruses with WHO Collaborating Centres (CCs) in order to support global pandemic preparedness. This obligation is reflected in the country capacity indicators. ⁸³⁹⁸⁴⁰ WHO regional reports list participating countries and the progress they have made. Benin does not appear in any recent (2022–2025) public publications related to the PIP, nor among the countries benefiting from the 'Contributing Partnership', nor among those that have shared influenza viruses. ⁸⁴¹⁸⁴²

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no evidence that Benin has not shared samples of pandemic pathogens during an outbreak in the past two years. There is no such information on the websites of the Ministry of Health. ⁸⁴³ Reports and publications from the World Health Organization (WHO) ⁸⁴⁴ and the World Organization for Animal Health (WOAH) ⁸⁴⁵ do not mention any such specific action by Benin during this period.

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 45

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 50

6.1.2a Orderly transfers of power

Score: 50

6.1.3a Risk of social unrest

Score: 50

6.1.4a Risk of terrorism

Score: 50

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5a Presence or risk of armed conflict

Score: 75

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 50

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 54.27

6.2.2a UNDP Gender Inequality Index score

Score: 23.69

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 36.12

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 50

6.2.6a Gini coefficient

Score: 65.6

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 50

6.3.3a Adequacy of power network

Score: 25

6.4.1a Urban population (% of total population)

Score: 53.37

6.4.2a Change in forest area (percentage points)

Score: 23.92

6.4.3a Natural disaster risk

Score: 100

6.5.1a Total life expectancy (years)

Score: 28.63

6.5.1b NCD mortality rate

Score: 68.52

6.5.1c Population aged 65+

Score: 89.88

6.5.1d Tobacco use (% of adults)

Score: 76.72

6.5.1e Level of adult obesity (%)

Score: 81.82

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 84.76

6.5.2a Access to potable water

Score: 69.96

6.5.2b Access to at least basic sanitation facilities

Score: 21.89

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 1.51

6.5.4a Trust medical and health advice from the government

Score: 0

6.5.4b Trust medical and health advice from medical workers

Score: 0