Q2 2026
West African Wastewater Surveillance
Strategic next steps

What each country should do

Phased actions per country, ordered by timeframe. The signature 2×2 visualisation (impact × feasibility) will plot every action once Genesis has scored them.

Signature visualisation — horizon scan 2×2 — pending impact_score and feasibility_score values. Today this page shows the structured action list.

DR Congo

Immediate · 0–2 years
  1. Finalise and publish standardised WES SOPs for sample collection, concentration, PCR, and sequencing for all actively surveyed pathogens (polio, Mpox, cholera).
  2. Conduct cost-effectiveness analysis of WES and prepare an investment case brief for MoPH leadership ('the only speech politicians understand').
  3. Develop financial SOPs for Gates Foundation grant compliance and reporting — a prerequisite for continued and expanded funding.
  4. Resolve import tax shortfall (~$34k/yr): engage MoPH for a formal exemption letter for WES reagents; submit to Customs as public health infrastructure.
Medium term · 2–4 years
  1. Align WES data with the national DSE (epidemiological surveillance) dashboard — integrate Mpox and cholera WES signals into MoPH weekly reporting.
  2. Decentralise sample concentration infrastructure to 3 provincial labs (Kisangani, Lubumbashi, Goma) to reduce costly 1-litre sample transport to Kinshasa.
  3. Draft a formal inter-ministerial coordination MOU between MoPH, MEDD, and MRHE establishing clear WES roles and data-sharing obligations.
  4. Expand to 52 sites (+2/region) covering all 26 provinces — beginning with regions where INRB already has outbreak response capacity.
Long term · 4–6 years
  1. Draft and pass a national WES policy — present to National Assembly with cost-effectiveness evidence, WHO endorsement, and INRB technical validation.
  2. Develop a One Health communication strategy — formally engage Ministry of Environment (MEDD) and Animal Health ministry to co-fund zoonotic WES sites.
  3. Expand to 70 sites (2× current urban + ~10% unsewered population coverage) using adapted open-sewer and river-catchment sampling methods.

Mozambique

Immediate · 0–2 years
  1. Formalise a national WES strategy document — a prerequisite for Global Fund eligibility and for WES inclusion in PES (national health strategic plan).
  2. Achieve domestic polio testing accreditation at INS Maputo — reduce dependence on NICD South Africa for confirmation, cutting turnaround from weeks to days.
  3. Establish dedicated WES field staff — separate collection team from laboratory staff to address the dual-role bottleneck and ensure 24-hour passive sampler windows.
  4. Formally integrate cholera WES data into MoH surveillance reporting — establish a data-to-action pathway linking WES results to outbreak response decisions.
Medium term · 2–4 years
  1. Decentralise concentration and PCR capacity to Sofala (Beira) and Nampula provincial labs — eliminating costly air freight of samples to Maputo.
  2. Add Influenza A&B and Rubella to the INS WES programme across all 38 current sites — leveraging existing infrastructure for incremental pathogen expansion.
  3. Submit WES to Global Fund as a component of the next national health grant — requires PES inclusion as the enabling precondition.
  4. Formalise the Intersectoral Working Committee (MoH, Public Works, municipalities) as the standing WES governance body with a formal secretariat at INS.
Long term · 4–6 years
  1. Expand to 56 sites (+2 per province) including peri-urban and WASH-priority communities — using adapted pit-latrine and tanker-effluent sampling where sewage is absent.
  2. Secure stable foreign currency access for reagent procurement via MoF agreement — classify WES reagents as essential health commodities under existing FX frameworks.

South Africa

Immediate · 0–2 years
  1. Submit a formal WES investment brief to National Treasury — outside the normal budget cycle, framed around value for money and averted healthcare costs. Target the July 2026 MTEF guidelines window.
  2. Re-establish the SACCESS-successor national coordination network under SAMRC/Pandemic Fund leadership — formalise with a steering committee, pathogen prioritisation framework, and quarterly meetings.
  3. Establish a national proficiency testing scheme for WES methods — propose NICD as the accreditation body; implement a round-robin scheme across the 6 SAMRC partner labs as a first step.
  4. Engage SALGA to formalise municipal access agreements for WWTW sites — draft a standard MOU template usable by all 8 metro municipalities.
Medium term · 2–4 years
  1. Develop and submit formal national WES policy/legislation to NDoH — framing WES as 'public health infrastructure', not research, to unlock operational budget classification.
  2. Integrate Mpox, Influenza, and Measles into the NICD national WES programme — moving these from the 'surveyed' tier to formally integrated, with dedicated budget lines.
  3. Submit value-for-money evidence to National Treasury before the July 2027 MTEF window — including cost per outbreak prevented and comparison with clinical surveillance costs.
  4. Expand SAMRC lab network from 6 to 12 partner universities — targeting previously disadvantaged institutions in Eastern Cape, KZN, and Limpopo.
Long term · 4–6 years
  1. Achieve national WES policy enactment — establish a legal mandate requiring municipalities above 500k population to participate in WES with data shared to the NICD.
  2. Scale to 80+ sites covering all 9 provinces including non-sewered communities (pit latrines, river run-off, tanker effluent) — using alternative sampling methods validated by SAMRC.
  3. Transition AMR/ESKAPE WES to routine surveillance integrated with GEMS-SA — creating a nationally representative antimicrobial resistance environmental monitoring system.

Ghana

Immediate · 0–2 years
  1. Leverage Ghana's existing $16M Pandemic Fund grant to integrate AMR-WES into national surveillance — building on Ghana's regional leadership in One Health.
  2. Develop a cost-effectiveness analysis for WES multi-pathogen scale-up — to support the case for domestic government expenditure expansion.
Medium term · 2–4 years
  1. Integrate SARS-CoV-2 WES into national surveillance system — building on existing polio/cholera/typhoid/influenza infrastructure.
  2. Explore IDA project vehicle for WES lab strengthening — if structured around health system strengthening with strong MoH ownership.

Nigeria

Immediate · 0–2 years
  1. Submit a WES component request to the $250M IDA Health Security Program (NCDC, 2025–30) before the mid-term review — the most immediate financing vehicle available.
  2. Apply for a Pandemic Fund grant — Nigeria has not received any PF grant and is an untapped resource. Frame around polio eradication monitoring and AMR surveillance.
  3. Engage Rotary Foundation for WES funding framed around polio eradication monitoring — Nigeria's status as one of the last poliovirus-endemic countries makes this a compelling ask.