Alignment with Africa CDC IPC legal framework

HAIs burden healthcare systems by increasing costs, morbidity, mortality, hospital stays, and reducing quality of life.^{Reference Boev and Kiss19} In Africa and other low-resource settings, systemic challenges intensify this impact.^{Reference Irek, Amupitan, Obadare and Aboderin20} The relatively strong alignment across IPC guidelines (average score 69%) reflects shared recognition of the threat posed by HAIs and HAIs–AMR. Aligning with regional standards is critical, as evidence shows effective IPC measures can cut HAIs by up to 50%.^{Reference Houghton, Meskell and Delaney21–Reference Umscheid, Mitchell and Doshi23} This alignment signals readiness to adopt interventions that lower infection rates, reduce hospital stays and costs, and improve patient outcomes.

Countries’ guidelines alignment with domains of IPC legal framework

Africa CDC IPC Legal framework highlights the need for national IPC programs.¹² Kenya and Nigeria have dedicated programs led by the MoH and NCDC, while Tanzania assigns oversight to a broader agency (MOHCDGEC). Dedicated programs strengthen accountability and coordination, whereas broader agencies risk competing priorities and implementation gaps.^{Reference Manchanda, Suman and Singh24,Reference Sengupta, Barman and Lo25} Stronger accountability structures increase the likelihood of consistent IPC policy enforcement, reducing preventable infections.

All three countries have established national IPC standards, although differences in alignment were observed across this domain. Nigeria’s guideline uniquely mandates annual review of IPC standards, highlighting the importance of regular updates to reflect evolving IPC practices.^{Reference Larson26} Kenya and Tanzania extend IPC standards across all administrative levels, whereas Nigeria’s focus is largely limited to HFs. While facility-level implementation remains essential, broader administrative coverage may support improved disease awareness and hygiene practices beyond hospital settings. Regular updates and wider administrative coverage ensure that IPC standards remain current and widely applied, which is essential for maintaining effectiveness in rapidly changing health contexts.

Strong alignment was observed across all three countries in IPC education and training for HCWs, consistent with evidence that training reduces HAIs and HAIs–AMR.^{Reference Larson26,Reference Igwe, Okolie, Ismail and Adukwu27} The Africa CDC framework stresses collaboration with relevant agencies, fulfilled by Kenya and Tanzania. Emerging evidence highlights integrating IPC training with bioinformatics, IT, and data analysis to match growing digitalization.^{Reference Larson26} High alignment in training is critical, as well-trained HCWs are frontline implementers, and without consistent training, even robust national IPC standards risk poor translation into practice.

Alignment on surveillance systems for HAIs varied. Nigeria and Tanzania outlined national systems coordinated by central bodies, while Kenya focused on facility-level surveillance. This reflects resource and capacity differences, as nationwide systems require major investment and many countries rely on facility monitoring.^{Reference Poirier, Boulanger, MacLaurin and Quach28} Yet HAIs can spread beyond facilities via HCWs and visitors, making broader coverage vital.^{Reference Alhumaid, Al Mutair and Al Alawi29} Localized surveillance limits early outbreak detection and response, allowing HAIs to spread unchecked across communities and undermining public health protection.

Differences were noted in monitoring compliance with national IPC standards. Tanzania showed strong alignment by mandating direct facility feedback to the national IPC program, while Kenya relied on indirect mechanisms such as newsletters, and Nigeria required facilities mainly to keep records. Effective monitoring depends on clear feedback loops to ensure accountability. None of the guidelines addressed mechanisms for managing non-compliance, negligence, or malfeasance—likely reflecting workforce constraints where punitive measures could worsen shortages.^{Reference Sheffel, Andrews and Conner30} Still, defined compliance mechanisms are vital. Without them, IPC standards risk remaining aspirational rather than operational, weakening patient safety and public health outcomes.

WHO stresses the need for facility-level IPC programs,¹² a requirement met by all three countries. Unlike Nigeria and Tanzania, Kenya’s guideline does not allocate a dedicated budget or specify staffing levels. Clear funding and staffing policies are vital, as facility IPC teams are the frontline of implementation. Without adequate resources, teams struggle to sustain practices, limiting their ability to prevent infections at the point of care.

We acknowledged several limitations in this study. First, it relied solely on published documents, which may not reflect actual practices or informal procedures. Second, interpretation of policy language involved some subjectivity, and terminology variations may have affected coding consistency. Finally, AU frameworks provide broad continental guidance, while each country retains authority to set priorities and adapt policies to its context. Thus, alignment with regional frameworks may not fully capture national decision-making, and differing priorities could limit comparability across countries.

In conclusion, the countries showed moderate-to-strong alignment with the Africa CDC IPC Legal Framework. Strongest alignment was in education and training and facility-level IPC programs, while weaker alignment appeared in HAIs surveillance and monitoring compliance. These findings highlight that workforce capacity and accountability are critical for implementation. Structural alignment provides a foundation, but without enforcement and trained staff, the public health impact of IPC measures is greatly reduced.

This study forms part of the succession planning within the DBF’s One Health Pan-African AMR Internship/Mentorship Programme. It reflects broader efforts to strengthen policy analysis and evidence translation capacity among early-career public health professionals in Africa. Such capacity building is critical for succession planning in Africa, ensuring that tomorrow’s public health workforce have a good grasp of AMR governance, to support the development of effective NAPs, and ensure that IPC strategies are informed by locally generated evidence.