Preparedness of the Ghana Health Service for field epidemiology and applied biostatistics: a systematic review of infectious disease surveillance, outbreak investigation methodologies, and statistical modeling capacities in resource-limited settings

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Introduction Infectious disease outbreaks continue to threaten global health security, with resource-limited settings facing disproportionate challenges in surveillance, outbreak investigation, and applied biostatistical capacity. The WHO International Health Regulations 2005 framework defines preparedness through measurable core capacities, and seminal multi-country analyses of IHR State Party Self-Assessment Annual Reporting data from 182 and 186 countries consistently show that sub-Saharan African countries report the largest preparedness gaps globally. Ghana, despite hosting the first Field Epidemiology and Laboratory Training Programme in West Africa, has not previously been the subject of a comprehensive synthesis of its preparedness across all relevant IHR domains. This review therefore addresses a single integrated question: to what extent is the Ghana Health Service prepared for field epidemiology and applied biostatistics, as assessed through surveillance system performance, outbreak investigation capacity, workforce development, laboratory infrastructure, and statistical modeling capacities aligned with WHO IHR core capacity benchmarks? Methods This systematic review followed PRISMA 2020 guidelines and was prospectively registered on PROSPERO (CRD420261299788). Searches were conducted in PubMed, African Index Medicus, AJOL, and Google Scholar, supplemented by grey literature, covering January 2000 to February 2026. Two reviewers independently screened 328 unique records, assessed 75 full-text articles, and included 38 studies with Ghana-specific disaggregated data. Quality was assessed using design-specific tools with transparent reconciliation into low, moderate, and high risk-of-bias categories. Narrative synthesis was the principal analytic approach. Results Surveillance completeness ranged from 71% to 94% (median 82%); timeliness ranged from 48% to 91% (median 76%), with regional performance substantially exceeding district performance. The GFELTP produced 420 graduates from 2007 to 2017, representing 45% of WHO-benchmarked workforce requirements. Outbreak response times improved from 14 to 3 days for comparable outbreaks. Laboratory capacity remained concentrated in 2 to 6 sentinel sites. No included study examined biostatistical modeling capacity. The 2017 WHO Joint External Evaluation rated overall IHR capacity at 67%. Discussion Ghana demonstrates advancing but incomplete preparedness. Priority interventions should address workforce expansion, peripheral surveillance strengthening, laboratory decentralization, and indigenous biostatistical capacity development. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261299788 , identifier: CRD420261299788.

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